Tuberculosis of intestine

Objective: to determine the clinical spectrum and surgical outcome of gastro-intestinal tuberculosis

Study design: descriptive case series

Place and Duration of study: department of General surgery ward 3 Jinnah Postgraduate Medical Center [JPMC] Karachi, from June 2010 - July 2015

Methodology: all patients who were diagnosed as cases of gastrointestinal tuberculosis and underwent operative procedures were included. Data was collected on a structured proforma. The variables collected included age of the patients, gender, clinical presentation, surgical procedures performed and outcome

Results: a total of 100 patients were managed. There were 67 female and 33 male patients. Female to male ratio was 2:1. The minimum age was 13 year and maximum 50 year with the mean age of 32 year. Apart from the constitutional symptoms like nausea, vomiting and low grade fever, abdominal pain was the commonest presentation. Eighty-eight patients were operated. End ileostomy, limited right hemicolectomy and resection anastomosis with primary repair were the commonly performed procedures. Two patients developed enterocutaneous fistulae. Five patients presented with septic shock and died

Conclusion: intestinal TB had varied presentation. It was found more frequently in females. Fever and weight loss were common presentations. High index of suspicion must be exercised in making a diagnosis

Comparison of fistulectomy with fistulotomy in low fistula in Ano

Objective: To compare the outcomes in terms of healing after fistulotomy and fistulectomy for low lying fistulae in ano

Study design: Cross sectional analytic

Place and Duration of study: Department of Surgery, Surgical Unit I, Jinnah Postgraduate Medical Centre Karachi, from June 2013 to May 2015

Methodology: Patients of both genders between 12 to 60 year of age with clinical diagnosis of fistula in ano were included in the study. Pain was assessed on visual and analog scale [VAS] Hospital stay was also recorded. All were followed for four week for any complications

Results: During the study period 120 patients were enrolled. Out of these 60 patients had fistulotomy and 60 underwent fistulectomy for fistula in ano. Male predominated with male to female ratio of 3:1. Swelling [86.6%], discharge [37%] and itching [27%] were the common symptoms. The mean duration of hospital stay was 3 +/- 1 day. Postoperative wound healing and pain assessed by VAS, were high in fistulectomy group. All patients recovered during follow up except one who continued to complain incontinence from fistulectomy group

Conclusion: Fistulotomy yielded better results as compared to fistulectomy for the treatment with low fistula in ano

Sleeve gastrectomy

The aim of our work is to present Experience of Sleeve Gastrectomy at Centre of Bariatric Surgery of Dow University of Health Sciences. All patients were assessed multidisciplinary team before operation. Indications for LSG were BMI 35kg/m[2] with comorbidites and BMI >40kg/m[2] without comorbidities. Standard surgical technique adapted. Gastric division by a cutting stapler. The whole staple line was observed for bleeding and tested for leak. Total 10 patients were studied of which were four males and six females, Median age of was 40 years. Pre-operative median BMI was 52.2kg/m[2] [range from 46 to 61kg/ m[2]]. Median post-operative BMI of 9 months was 34.33kg/m[2] [range from 28 to 40]. Out of 10 patients, observed complications of bleeding was seen in one case and wound infection occurred in 2 cases. Considerable weight loss observed in LSG

Frequency of thyroid cancer at King Fahad hospital, Madinah

To assess the frequency of common thyroid cancer at king Fahad Hospital, Madinah. Retrospective study. This study was carried out on all the patients treated for Cancer of Thyroid Gland, at King Fahad Hospital [KFH]-Madinah between Jan 2009 to February 2012. Ninety-one patients diagnosed with Cancer of Thyroid of various Age, Sex and Races were registered with King Fahad Hospital Madinah. 75% patients were Saudi nationals, 10% patients were from other Arab countries and the remaining 15% were non-Arabs. There were 72% females and 28% Males. The Ages ranged from 14 years to 94 years. 34% of these patients were less then 30 years of Age at the time of the diagnosis. Over 90% of the cases presented with Swelling Anterior Neck while in other 10% of the cases Dysphagia or Dyspnoea with Rt. or Lt. supraclavicular masss/swelling was the major complaint. 71% patients under went various surgical procedures for the Neck swelling. The Total Thyroidectomy was done in 48% patients. The Histology revealed 52% of pure Papillary Carcinoma and 23% were of Follicular origin. Majority of the diagnosed patients of Ca. Thyroid were referred to King Faisal Specialist Hospital Riyadh for Radioactive Iodine Ablation Therapy. The follow-up was poor as patients were from highly mobile population and belonged to Nine different countries. The study reveals that the presentation of Ca. Thyroid in our series is essentially similar to what has been reported from other parts of the world

To compare the frequency of superficial surgical site infection after laparoscopic versus open appendectomy

To compare the frequency of Superficial Surgical Site infection after laparoscopic versus open appendectomy. Randomized clinical trial study. This study was conducted at Surgical Department Jinnah Post Graduate Medical Centre Karachi and Dow University Hospital from August 2013 to January 2014. The source of data was patients admitted in emergency. Patients were selected on the basis of clinical features. The data was collected with the help of Performa attached. It included demographic data of the patient, presenting complaints, operative findings, Surgical site infection. Random patients were placed in two groups. Surgical site infection by observation of pain, redness, tenderness and purulent discharge from the wound. Patients included were of both gender and age above 13 years presented to emergency department diagnosed as acute appendicitis on the basis of history and examination and exclusion of under 12 years of age, appendicular mass, CLD, I.H.D, DM and renal failure. Out of 270 patients, 153[56.7%] patients were males and 117[43.3%] patients were female. In Present study the different operative findings with their distribution among gender are shown in table. In other findings three patients with ruptured ovarian cyst and one with Mackel's Diverticulitis in which procedure was converted to open and resection and anastomosis of small intestine was done. SSSI is found to associated with operative finding with a significant P value 0.001. Superficial Surgical Site Infection were observed in both procedure laparoscopic appendectomy allotted in 134 cases but four cases are converted to open procedure so they are excluded from the results. The reason for conversion in three cases was difficulty in mobilizing the appendix because of adhesion and in one case Mackel's Diverticulitis found which need open procedure for formal small intestine resection and anastomosis. Superficial Surgical Site Infection was observed in three cases of Laparoscopic appendectomy and in 15 cases of Open Appendectomy group with the P value 0.005. Laparoscopic appendectomy is a better choice because of its reduced frequency of SSSI when compared with open procedure. SSSI is an important complication

To determine the frequency of raised C-reactive protein in patients of acute pancreatitis

To determine the frequency of raised c-reactive protein in patients of acute pancreatitis. Cross sectional study. This study was conducted at Surgical Department Jinnah Post Graduate Medical Centre Karachi and Dow University Hospital from January 2013 to June 2014. The patients were selected on the basis of clinical features. Take detailed history regarding epigastric and upper abdomen pain. All the patients of either gender with acute abdominal pain presenting to emergency and diagnosed as acute pancreatitis by serum amylase of 1000 units or more were included in the study. Ranson Scoring and C reactive protein levels on admission were noted. A total of 144 patients, both males and females were included in the study. 17[11.80%] out of 144 subjects were males and rest were females 127[88.19%] cases. The minimum age was 25 years and maximum was 60 years but most of the patients were in the range of 40 to 55 years means age was 43 +/- 6.7 years. The minimum value was found to be 25 mg/L while maximum was 57 mg/L. Mean CRP was foud to be 32.2 +/- 11.43 mg/L for that group of patients. All the patients were also categorized as mild and moderate to severe on the basis of Ranson's criteria. 73% patients were found to have mild disease with rest having moderate to severe disease. Frequency of CRP observed in our study were in 139[96.52%] cases. We concluded that C reactive protein was a useful severity assessment marker in patients with acute pancreatitis and it can be proposed as an important single factor for determining severity of patients presenting with acute pancreatitis

Choledochorraphy [primary repair] versus t-tube drainage after open choledochotomy

T-tube drainage used to be standard practice after surgical choledochotomy, but there is now a tendency in some canters to close the common bile duct primarily. This study was designed to compare the clinical results of primary closure with T-tube drainage after open choledocotomy and assess the safety of primary closure for future application. This study was conducted at surgical Unit-3, ward 26 Jinnah Postgraduate Medical Centre Karachi, from January 2007 to January 2008. Forty patients were included in this study out of which 20 underwent primary closure and 20 Ttube placements. It was Quasi-experimental, non-probability, purposive sampling. Main outcome measures were operating time, duration of hospital stay, and postoperative complications. SPSS-10 was used for data analysis. The age of patients in the study ranged from 29-83 years. There were 3 male while 37 female patients. Group-1 consisted of 20 patients underwent primary closure after choledocotomy, while Group-2 also consisted of 20 patients underwent T-tube drainage after duct exploration. Mean hospital stay in Group-1 patients was 7.63 days while in group 2 it was 13.6 days. Overall complication rate in group 1 was 15%, biliary leakage in 1 [5%], jaundice in 1 [5%], wound infection in 1 [5%]. No re-exploration was required in Group-1. In Group-2 overall complication rate was 30%, biliary leakage in 2 [2%], jaundice in 1 [5%], dislodgement of T-tube in 1 [5%], wound infection in 1 [5%], and sepsis in 1 [5%] patients. Re-exploration was done in one patient. Primary closure of Common Bile Duct [CBD] is a safe and cost-effective alternative procedure to routine T-tube drainage after open choledocotomy.

Profiles of community acquired pneumonia cases admitted to a tertiary care hospital

To assess the demographic profiles of community-acquired pneumonia. A cross sectional study was carried out for one year, recruiting 160 hospitalized community-acquired pneumonia [CAP] patients, selected by non-probability convenience sampling method. Demographic variables such as age, gender, education, marital status, residential and socio-economic status were inquired into along with Haemoglobin estimation, Diabetes, Hypertension and Ischaemic heart disease by Pre-designed Questionnaire Performa. Data collected was analyzed by SPSS-14. Out of 160 patients, majority respondents 88 [55%] were males [P < 0.05], while 90 [56.25%] had rural residents predominance [P < 0.05]. It revealed 140 [87.5%] respondents were married [P < 0.05], while 18 [11.25%] were < 20 years, 68 [42.5%] were between 20-40 years, 58 [36.25%] from 41-60 years and 16 [10%] were > 60 years of age. There were 110 [68.75%] illiterates from lower socio-economic class. Haemoglobin level was 8-10 gm/dl among majority 80 [50%], and 34 [21.75%] were Diabetics.CAP is frequent among males, rural residents, illiterate, anaemic, diabetics and lower socio-economic married patients from 20-40 years of age

Role of urgent thoracotomy in improving the survival of patients with severe chest trauma

To determine the frequency of survival in patients with thoracic trauma, undergoing Urgent Thoracotomy [UT]. Quasi-experimental study. The study was carried out in the Department of Thoracic Surgery, JPMC, Karachi, from January 2005 to June 2007 [30 months]. Fifty two patients, who presented with chest trauma and underwent UT within 48 hours of sustaining thoracic trauma, were included in the study. All patients were assessed by history, physical examination and relevant investigations. A total of 475 patients with acute thoracic trauma needing admission during the study period presented to the Accidents and Emergency Department. Fifty-two [52/475; 10.9%] patients were indicated for UT. The most common indication for UT was massive hemothorax [43/52; 82.6%]. The mean age of the patients was 34.36 +/- 11.02 years. There were 22 [42.2%] blunt injuries and 30 [57.8%] penetrating injuries. Road Traffic Accidents [RTA] were the most frequent cause of blunt chest injuries [15 patients; 75%], while firearm injury was the commonest [21 patients; 70%] cause of penetrating chest trauma. Post thoracotomy mortality was 13.3% [4 out of 30] in patients with penetrating injuries and 18.2% [4 out of 22] in patients with blunt injuries [p < 0.01]. Mortality of UT was 15.3% with survival of 84.7%. Overall survival in 475 patients was 95.58%. Early recognition of treatable injuries and an aggressive approach in management with Urgent Thoracotomy can increase chances of survival of patients suffering from severe chest trauma

Perforation operation interval as a prognostic factor in typhoid ileal perforation

To find out significance of perforation-operation interval [POI] in relation to early prognosis in patients with peritonitis due to typhoid Heal perforation [TIP]. Case series. Department of General Surgery, Jinnah Postgraduate Medical Centre [JPMC] Karachi, from October, 2004 to March, 2007. The study included 92 patients with generalized peritonitis diagnosed as typhoid Heal perforation Methods fulfilling the inclusion criteria. All non typhoidal and traumatic perforations were excluded from the study. Data was collected in the proforma designed for the study. The diagnosis of typhoid Heal perforation was established on the basis of history, clinical examination, radiology, isolation of Salmonella Typhi, and a positive Widal test. Histopathological confirmation of the diagnosis was also made. Out of 92 patients, 75 were males [81.5%] and 17 [18.5%] females, with male to female ratio of 4.4:1. The ages ranged between 15 to 50 years. The most common symptoms were fever [100%], abdominal pain [100%], constipation [81.5%], vomiting [76%] and distension of abdomen [69.5%]. The most common signs elicited on abdominal examination were tenderness [100%], guarding [72.8%] and absent gut sounds [65.2%] Out of 92 patients 12 patients [13%] presented within 24 hours of onset of severe abdominal pain [Group A]. Among late presenters, My nine [64.1%] patients presented 25-72 hours after severe abdominal pain [Group B] and twenty one patients [23%] presented after 72 hours [Group C]. Mortality was highest among group C patients [8/21 ;38%], while the mortality among the late presenters [Group B] was 10.2% [6/59]. There r was no mortality in the early presenters [Group A]. Overall mortality was 15.2% [14/92]. The average perforation operation interval in survivors was 44.2 hours as compared to average of non-survivors- 63.9 hours [p <0.01]. Prolonged presentation time leads to a high mortality rate. Once intestinal perforation occurs, early recognition, early referral and aggressive management could decrease the high mortality

Frostbite during Kashmir conflict

The aim of this study was to evaluate different modalities of management of cold injuries including gradual re-warming, administration of vasodilators, and surgical intervention. A total number of 2564 cases of frostbite were treated during December 1988 to March 2003, mostly at local hospitals of Muzaffarabad, Azad Kashmir. The frost bitten cases were refugees who suffered frostbite during their movement across the line of control alongside the Himalayan mountains over 12000 feet altitude above sea level. Management of these patients involved multidimensional approach with prudent strategy [if frost bitten in January amputate in June.] The patients were categorized into four groups depending upon the severity of injury. All the patients were gradually rewarmed. The severally injured [100%] and moderately injured patients [50%] were administered 5 mg nifidepine, 5 ml 1% lignocain in femoral vessel, alongwith administration of systemic antibiotics accompanied by limited wound debridement and wound dressing. Patients were watched till clear demarcation line appeared between the live and dead tissue. Sequelae of cold injuries and the rate of complications reduced by adopting this management policy

Gastric carcinoma: 5 years survival after gastric surgery

To study the five years survival rate after resection for gastric carcinoma. Fifty six patients with gastric carcinoma in different stages were followed up for 5 years after gastric surgery to see recurrence, complications and survival rate. Of the 56 patients, 6 underwent total gastrectomy, 50 partial gastrectomy, 7 Billroth I and 43 modified Dl resection with Billroth II reconstruction. Six patients were alive at the end of 5th year, 3 with early gastric carcinoma and 3 with locally advanced carcinoma. Mortality was 17 patients in the first year, 10 in second year, 8 in third year, 3 in fourth year and 1 in the fifth year. Gastric carcinoma carries a bad prognosis. The 5-year survival rate in our series was 1.3%. Efforts should be made to diagnose and treat these patients at an early stage