Retrieval of gallbladder through epigastric port as compared to umbilical port after laparoscopic cholecystectomy

This comparative prospective study was conducted at the Ghulam Muhammad Mahar Medical College Hospital and Red Crescent General Hospital, Sukkur, Pakistan, for a period of two years from July 2012 to June 2014. The study included 1800 patients who underwent laparoscopic cholecystectomy for symptomatic cholethiasis. These patients were divided in to two groups. Group I included 900 patients, who underwent conventional laparoscopic cholecystectomy with the four port technique. In these patients, the gall-bladder was retrieved through umbilical port by a sterile surgical hand glove [size 6[1/2] or 7 inches] endobag. The fascial defect of 10 mm umbilical port was closed by vicryl "0" with J-shaped needle, while three 5 mm ports closed by applying steri strips. Group-II also included 900 patients. In these patients laparoscopic cholecystectomy was done by using three ports, 10 mm epigastric working port, 5 mm umbilical port for 5 mm telescope and lateral 5 mm port for assistant. The gall-bladder was retrieved through epigastric port without endobag. The results of both these techniques were collected and analyzed on SPSS version 14. The mean age of patients was 45 years. The male to female ratio was 1:3. In group-I, after laparoscopic cholecystectomy, gall-bladder was retrieved safely through 10 mm umbilical port in surgical glove endobag. In acutely inflamed cases, the gall-bladder was opened at the umbilical port site inside the endobag and decompressed before retrieval. In this group, wound infection of umbilical port occurred in 5.11% patients, port-site hernia in 3.66%, port-site bleeding in 1.33% while difficulty in retrieval of gall-bladder in acutely inflamed cases in 1.88% patients. In group-II, wound infection in epigastric port was found in 1.55% patients, port-site hernia in 0.11%, port-site bleeding in 4%, difficulty in retrieval of gall-bladder in 5.33% while leakage /perforation of gall-bladder in 4.11% patients. The serious complications like wound infection and port-site hernia are more frequently found in group-I patients as compared to group-II

Otolaryngologic manifestations of gastroesophageal reflux disease

To determine frequency of endoscopic oesophagitis in the patients who complain the chronic laryngopharyngeal disorders in the absence of typical gastroesophageal Reflux Disease [GERD] symptoms. Descriptive study The study was carried out in the department of E.N.T at Nawabshah Medical Centre, Nawabshah over the period of two years [2004 to 2006]. One hundred patients of either sex and in the age group between 25-79 years with symptoms of chronic laryngopharyngeal disorders were selected for study. All patients had physical examination of upper aero digestive tract. Direct laryngoscopy was done to evaluate the status of larynx, however rigid esophagoscopy was done to evaluate the status of esophageal mucosa and biopsies from lower part of esophagus were taken in all patients. Eighty percent of patients with symptoms of chronic laryrigopharyngitis were also suffering from microscopic Oesophagitis. Among the 80% patients 87.5% were having non-erosive oesophagitis while 12.5% were having erosive oesophagitis. In significant number of patients with chronic upper respiratory symptoms resistant to the treatment, there was co existing gastroesophageal disease which could be the cause of the symptoms

Common bile duct pathologies at Nawabshah

To determine the causes, prentation, management and outcome of Common Bile Duct [CBD] pathologies. Descriptive analytical study from January 1995 to December 2006. Surgical Unit-I, Nawabshah Medical College and Hospital, Nawabsheh. All patients who presented with CBD pathologies. Data of all the patients with CBD pathologies was collected and entered on a proforma, including their complaints, positive examination findings, investigation, diagnosis, procedure performed and its outcome. During the study period 45 patients presented with CBD pathology. Amongst them 14 were males and the rest females [31], with a mean age of 36.7 years. Around 67% patients had choledocholithiasis as the commonest cause. Exploration of the CBD with T-tube insertion was the commonest procedure, performed in 69% patients. About 4% patients had retained stones and 20% developed wound infection. Mean hospital stay was 13 days. Most common pathology involving the CBD was secondary stones; 95% patients had associated gall stones also

Tuberculosis of the breast: a cytomorphological study of nine cases

To determine the role of FNAC with histological confirmation in the diagnosis of tuberculous mastitis, and to highlights its importance by determination of frequency, clinical history, clinical presentation and laboratory investigations in our setup. A retrospective case series from Jan. 1997 to Dec. 2006. Department of Pathology, Nawabshah Medical College, Nawabshah. Nine patients with mammary tuberculosis. The data was collected from patients files and other record, and the results tabulated. All were married multiparous women, aged 18-42 years, belonging to poor socio-economical class. One was pregnant, while three were lactating mothers. Associated pulmonary tuberculosis was present in three cases. Previous history of tuberculosis was present in one case, though five patients had a family history of tuberculosis. Lump in the breast, with or without ulceration/ abscess/ discharging sinus was the clinical presentation of all the cases, as was low grade fever and pain. All patients had anemia and weight loss, though axillary lymphadenopathy was seen in five cases. ESR was raised in all the cases and the Mantoux test was positive. The glutaraldehyde test was positive, though it was performed in three cases only. AFB were seen in one case only. The diagnosis was made on FNAC by the presence of chronic granulomatous inflammation having caseating epithelioid granulomas and Langhan's type of giant cells. The cytological diagnosis was confirmed by histopathologicaI findings of excisional biopsy specimen in all the cases. The present study highlights the importance of tuberculous mastitis; its frequency being 2.3% in breast diseases. FNAC is an important initial diagnostic tool in patients having tuberculous mastitis, specially in the rural areas. It is safe, rapid, simple, cost effective and accurate, the accuracy being 100%

Gleason grading of carcinoma prostate at Nawabshah medical college / Hospital

To evaluate the Gleason Score and pathological grading of patients with Carcinoma of the Prostate amongst prostatectomy specimen. A retrospective study from January 1996 to December 2005. Nawabshah Medical College Hospital, Nawabshah. A total 4595 patients who underwent prostatectomy. Detailed data of the patients was retrieved from the case sheets, ward records and the Pathology Department by manual search, and analyzed. Amongst the total 595 cases, the age range was 50-90 years with a mean age 465.08 years. Out of the 595 prostatectomy specimen submitted during the study period, 46 [7.73%] had adenocarcinoma. According to the Gleason Score 18 [39.13%] cases had well differentiated [Score 2-4], 24 [52.17%] had moderately differentiated [Score 5-7] and four [8.69%] cases had poorly differentiated [Score8-10] adenocarcinoma. Gleason Score is a universally accepted prognostic indicator of Carcinoma Prostate. Pathologists must report consistently for the better management of the condition

Outcome analysis of transvesical prostatectomy in our setting

To evaluate the outcome of suprapubic transvesical prostatectomy in our setting. Prospective and descriptive audit from July 2002 to July 2005. Department of Surgery, Peoples Medical College Hospital, Nawabshah. A total of 120 patients with lower urinary tract obstruction due to benign prostatic hyperplasia [BPH]. The details of all the above mentioned patients were recorded and the data analyzed for age, presentation, accompanying problems, blood transfusion, hospital stay, complications and mortality. The age range of the patients was from 50-90 years, mean age being 64.73 years. The indications for surgery were retention of urine in 64 [53.33%] cases, prostatism in 53 [44.17%] and haematuria in three [2.5%] cases. Associated problems were seen in 73 [60.83%] patients, including bladder stones in 19 [15.83%], inguinal hernia in 15 [12 .5%], haemorrhoids and renal stones in four [3.33%] each, and medical problems in 30 [25%] patients. The average operation time was 67.5 minutes and 51 patients needed blood transfusion [1-3 units]. Complications were seen in 49 [40.83%] cases including haemorrhage and urinary tract infection in eight [6.67%], clot retention in six [5%], wound sepsis in seven [5.83%], and transient incontinence and suprapubic urinary leakage in five [4.17%] cases each. The post-operative mortality was in 1.67% [two cases]. Transvesical prostatectomy [TVP] performed under spinal anesthesia is a safe and effective way of managing BPH. Its success has a durable effect and is a satisfactory modality in situations where facilities for transurethral resection of prostate [TURP] are not available

Correlation of age with histopathological type of testicular tumors

The aim of the study was to find out the frequency and histopathologic type of various testicular tumors in correlation with age of the patients in our setup. It was a retrospective, descriptive study carried out at the Department of Pathology, Peoples Medical College, Nawabshah, Pakistan. All testicular tumors diagnosed from January 1991 to December 2005 were included in the study. The clinical data and surgical pathology reports with haematoxylin and eosin stained slides were obtained from the record. All the cases were reviewed and results tabulated. The patients were divided into six age groups and the tumors classified according to the pathological classification of testicular tumors. During this period 73 cases of testicular tumors were diagnosed in the department. All cases were diagnosed as germ cell tumors [100%]; consisting of 57 [78.1%] cases of single histologic type and 16 [21.9%] cases of mixed germ cell tumors. Most of the cases presented in the 3[rd] and 4[th] decades. Seminoma was found to be the commonest tumor in 27 [37%] cases, embryonal carcinoma in 29 [27.4%] cases, teratocarcinoma in 11 [15.1%] cases, yolk sac tumor and teratoma each in 5 [6.8%] cases, embryonal carcinoma with seminoma in 3 [4.1%] cases and teratoma with seminoma in 2 [2.8%] cases. In this study the ages of the patients and the frequency and histopathological findings in testicular tumors, with few exceptions are similar to other studies from different parts of the world, confirming the worldwide similarity of these parameters

unusual foreign body in the urinary bladder

Foreign body in urinary bladder being unusual in clinical setting presents as a diagnostic dilemma with vague history. Bladder calculi are uncommon in adults and usually result either from obstruction or foreign bodies. The present case report describes a young girl presenting with cysticism. Investigations revealed a bladder calculus encrusted on trans-urethrally inserted abortion stick in the urinary bladder that warranted surgery. Endoscopic manipulation was successful. Postoperative period was uneventful