ABSTRACT
To identify various factors which prolong post-operative hospital stay after laparoscopic cholecystectomy. This is an observational prospective study conducted at a teaching hospital over a period of five years [Jan 2005-Dec 2010] and includes 580 patients of symptomatic cholelithiasis, admitted and treated by laparoscopic surgery. All patients were observed from 1st postoperative day to date of discharge and different operative, postoperative and patient related variables were recorded on a proforma which were found responsible for an unduly prolonged post-operative stay in the hospital. The duration decided for short stay was 48 hours and duration more than that was considered as prolonged stay. Out of 580 patients, 187 [32.24%] had prolonged stay extending from 3-28 days. Majority of patients presented in 4[th] and 5[th] decade [60.52%] with pain in right hypochondrium [58.79%] and pain in right hypochondrium combined with pain in epigastrium [27.6%] as main clinical features. Twenty eight variables were identified comprising of 10 patients related [15.86%], 12 surgery related [16.55%] and 6 post-surgery related [16.38%] which contributed to prolong the hospital stay. Patients having co morbid conditions, difficult operative procedure and major postoperative complications were main factors for prolonged stay. The prolonged post-operative hospital stay can be reduced by careful pre-operative assessment, meticulous surgery and proper post-operative management
ABSTRACT
To determine the aetiological factors, presentation and management of acute pancreatitis and to assess the outcome of different forms of management in our set up. A case series. Liaquat University Hospital, Jamshoro/Hyderabad - Sindh from January 2002 to December 2004. The data of 45 consecutive patients admitted with acute pancreatitis was collected through a proforma and assessed with reference to aetiological factors, clinical presentation and management in each case. Majority [60%] of the patients belonged to 30-40 years of age. Thirty-six [80%] patients presented in emergency. The most common aetiological factor for acute pancreatitis was gallstones and the pain, nausea and vomiting were the main symptoms. Serum amylase [>3 x normal] was seen in 36[80%] patients. Prediction of severity was identified through Ranson score. It was <3 in 27[60%], 3 in 13[28.9%] and 4 in 5[11.1%] patients. The mortality was 13.33% but the morbidity remained high with the sequelae of resolution in >50% cases. Acute pancreatitis in our set up shows a lower frequency of this disease when compared to the world literature. However, when compared with aetiology and presentation, the pattern remains the same. Meanwhile, due to adoptation of Western way of life, the incidence seems to be increasing. Due to patient's delayed arrival, the diagnosis depending upon the level of serum amylase seems to be misleading
Subject(s)
Humans , Male , Female , Pancreatitis/diagnosis , Pancreatitis/therapy , Acute Disease , Disease Management , Risk Factors , Hospitals, UniversityABSTRACT
To highlight diagnostic difficulties and evaluate the outcome of malignancy in nodular goiter. Case series. This study was conducted in the Surgical Unit-III and Unit-IV at Liaquat University Hospital Jamshoro, from January 2001 to December 2004. Nodular goiter patients admitted for treatment were studied with the help of a pre-designed proforma for recording the personal history, blood chemistry and FNAC results. The results of FNACs were further compared with the tissue histology postoperatively. During the four year study period 14 patients had malignancy out of total 149 cases of nodular goiter admitted. Twelve patients were diagnosed on FNAC. These patients were operated and near total thyroidectomy was done. Two patients diagnosed to have carcinoma on tissue biopsy [FNAC did not pick the malignancy] were re-admitted and had near total thyroidectomy. One patient with lymphoma was referred to Department of Oncology for radiotherapy. All patients with neoplasm postoperatively were referred to oncology department for further management to suppress the TSH. Near total thyroidectomy is the surgery of choice to decrease the recurrence rate in thyroid malignancies