Microbiology of bile in symptomatic uncomplicated gallstone disease

To determine the microbiology of the bile culture and antimicrobial susceptibility in patients with symptomatic gallstone disease in our setup. A descriptive study. Surgical Department Combined Military Hospital [CMH] Kharian from Oct, 2010 to Jun, 2011. A total of 106 patients underwent cholecystectomy due to symptomatic gallstones and their bile was cultured for aerobic and anaerobic bacteria and culture sensitivity was performed. Data was analysed by using statistical package for social sciences [SPSS] version 13. Bile culture was negative in 81 patients [76.4%] and was positive in only 25 patients [23.6%]. Escheria Coli was the most common cultured organism in 10 [40%] patients, Klebsiella in 5 [20%] patients, Pseudomonas in 5 [20%] patients, Proteus in 2 [8%] patients, Staphlococcus aureus in 2 [8%] patients and mixed organisms were cultured in 1 patient [4%]. Cefoperazone with sulbactum and Amikacin were the most effective prophylactic antibiotics. Bile in majority of patients with symtomatic uncomplicated gallstone disease is sterile. E. coli is the most commonly cultured organism and cefoperazone with sulbactum and amikacin are the most appropriate antibiotics in our setup

Endoscopic disectomy: learning curve and outcome evaluation

Background: Minimally invasive techniques for Lumbar disc surgery are becoming common. It is therefore essential that we assess their learning curve and evaluate their results before their across the board application to lumbar disc herniation surgery

Objective: This prospective study was conducted to evaluate steepness of learning curve and outcome of Endoscopic disectomy

Study Design: This is a prospective study carried out at PNS Shifa, which is a tertiary care hospital, from Jan 2011 to Jan 2013

Patient Interventions: Forty three patients underwent Endoscopic disectomy for a single level herniated disc using an interlaminar approach; all procedures were performed under general anesthesia. All patients were followed prospectively. Endoscopic system used in this study consisted of tubular dilators and an endoscope with xenon light source and HD image system from Karl Storz co. Germany

Outcome measures: Outcomes were assessed by analyzing the video of the procedure to pinpoint the areas where maximum time was spent and thus devising ways to cut down the operating time. Patient outcome was measured by using Oswestry disability index and Macnab criteria

Results: 43 patients [29 males, 14 females] underwent Endoscopic disectomy for prolapsed lumbar intervertebral disc. Mean operating time was 70 minutes. The mean operation time for the first and last 10 cases was 140 and 58 minutes, respectively. The procedures affecting a prolonged operation time were evaluated. The time required for surgery reduced considerably after 12 cases. Follow up ranged from 3 to 15 months with a mean follow up of 10.8 months. Thirty five patients had an excellent outcome while five had a good outcome. Three patients had a poor outcome and underwent open disectomy. Five patients early in the study had to be converted to open disectomy due to technical difficulties. These cases were excluded from the study

Conclusions: Endoscopic disectomy is clinically effective and reliable. The learning curve, however, is steep. It requires at least 10-15 cases before surgeon can achieve command of the procedure

Radial nerve injuries; presenting as wrist drop-analysis of 100 patients

To highlight etiological factors leading to radial nerve injury resulting in wrist drop, with particular reference to iatrogenic causes. Retrospection and Descriptive. One hundred patients of all ages and both sexes with wrist drop. Data of clinical assessment after detailed history and examination as well as electro diagnostic studies was recorded on pre-designed assessment proforma. The outcome was charted down for frequency of etiology of the wrist drop. Rehabilitation Medicine Department of Combined Military Hospital [CMH] Multan and Armed Forces Institute of Rehabilitation Medicine [AFIRM]. The major cause of injury was splinter/gun shot injury 31%, mis-placed injection at mid-arm 21%fracture of humerus was 21%, compression neuropathy 16%, and stab wound 11% caused wrist drop. Electro-physiological studies revealed that 85% patients had injury to radial nerve at mid-arm, 9% had injury to posterior interosseous nerve while 4% had injury to superficial branch of radial nerve and only 2% had normal study. Electrodiagnostic studies also revealed that majority of the patients suffered from axonotmesis [44%] and neurapraxia [38%], whereas [16%] were neurotmesis. The most common cause of radial nerve injury is trauma. It is also found that the frequency of radial nerve palsy due to iatrogenic causes is quite high. In addition to the clinical examination, the nerve conduction studies and electromyography proved to be the better investigation technique in the assessment of the location, severity and extent of the peripheral nerve injury and subsequently guides in starting the proper treatment option due to early referral of patient to the concerned fields

Frostbite in gangrene; role of classification

The objective of this study is to determine if classification of cases of frost bite in 1st, 2nd, 3rd and 4th degree have any predictive value on the future complications e.g. skin necrosis and gangrene. A non-interventional and descriptive study. The study was carried out at the Surgical Department, of Combined Military Hospital Gilgit from January 2002 to February 2005. All the patients who reported to the hospital with frost bite were admitted and enrolled in the study. The local examination of wound was done and all the physical signs were recorded, The frost bite was labeled according to the severity from 1st to 4th degree in accordance to the specified criteria. All the patients were placed on a standard treatment protocol comprising of injection of Benzyl Penicillin 10 lac U x 6 hourly, injection of Heparin 5000 IU s/c x 6 hourly and tablets Ibuprofen 400mg x 8 hourly for 5-7 days. The condition of wound was assessed daily till 8 weeks after admission. The end point of medical treatment was a clear demarcation of dry gangrenous and viable tissue, or the formation of moist gangrene or infection in frost bitten area which was spreading proximally. Once this condition was reached the patients were planned for amputation surgery. Total numbers of patients included were 96. Among them 33 had 1st degree, 37 had 2nd degree, 16 had 3rd degree and 10 had 4th degree frost bite. All the 33 patients of 1st degree frost bite recovered well and were discharged from the hospital without any surgical intervention. 16 patients among the total 37 who sustained 2nd degree frost bite developed superficial ulcers over the skin. These patients required regular wound dressings and recovered well by 6 weeks of treatment without any limb loss. 7 out of total 16 patients of 3rd degree and all the 10 patients of 4th degree frost bite developed gangrenes. They were observed till 8 weeks and after that they underwent amputations. In accordance to the results it is concluded that most of the patients who had r degree of frostbite and all the patients who sustained 4th degree frost bite developed gangrene by 8 weeks of hospitalization despite of the treatment. None of the patient of 1st and 2nd degree frostbite developed gangrene. Hence the initial assessment of a patient was very useful in predicting the chances of development of gangrene

Aetiology of nasal polyp-a study of 200 cases at combined military hospital Rawalpindi

To know the aetiology of nasal polyp in our setup so that the underlying cause can be addressed at the same time for a better treatment outcome. DESIGN. This is a descriptive study. PLACE AND DURATION OF STUDY. The study had been carried out at the ear, nose and throat department, Combined Military Hospital Rawalpindi, a tertiary care centre, over a 03 years period from January 2000 to January 2003. PATIENTS AND METHODS: The study was carried out on 200 patients. Patients of all age groups and both sexes who presented for the first time in our setup and found to have nasal polyp / polypi on examination, were included in this study. Patients who had history of nasal polypectomy with no nasal polyp at the time of presentation were excluded from the study. On the basis of detailed history, thorough clinical examination and investigations patients were placed in different groups like intrinsic rhinitis [vasomotor rhinitis], nasal allergy, sinonasal infection, sinonasal growths, drug allergy [aspirin hypersensitivity] and cystic fibrosis. In this study majority of the patients were found to be in second to fifth decade, male to female ratio was 2:1, 59% were diagnosed to have vasomotor rhinitis, 18.5% had nasal allergy, 12% had asthma, 14% had fungal rhinosinusitis, 4% had acetylsalicylic acid hypersensitivity, 6% had sinonasal growth, 2% had bacterial rhinosinusitis and 0.5% had cystic fibrosis. 84% of our patients turned out to be having bilateral nasal polypi, 16% had unilateral nasal polyp, out of which 6.5% antrochoanal polyp. The exact cause of nasal polyp is still an enigma, majority has simple aetiology but nasal polyp with sinister pathology-do present. So the management of nasal polyp should only at the symptomatic relief of nasal obstruction but the underlying cause and pathologies should also be addressed

Otological manifestations of bomb blast injury

The study was conducted to assess the spectrum and pattern of otological injuries in bomb blast. Observational/non-interfering descriptive study of the trauma to the auditory system in a bomb blast in a bus was explored. This study was conducted from 28 to 30 Oct. 2001 in a tertiary care hospital, following a bomb blast in a bus on 28'h October 2001. An explosive charge detonated under a seat in a local urban transport bus on 28th October 2001, killing 3 passengers on the spot. All the survivors who required medical treatment were transferred to a major medical facility located about 100 metres from the scene of the incident. All those, admitted or reporting to ENT Department, were examined for any ear nose or throat injury. In the otological evaluation the audiological and vestibular symptoms were recorded and tuning fork tests, pure tone audiometery and Hallpike manoeuvre were also performed. The otological manifestation of blast trauma were hearing loss, tinnitus, ear discharge and pain. Vertigo was not a symptom of blast trauma. Perforation of tympanic membrane was a common sign in blast trauma. Sensorineural hearing loss was also one feature of bomb blast injury. Typical noise induced deafness was found in 36% of total ears tested on PTA. The 256 Hz tuning fork was more sensitive in detecting conductive deafness as compared to 512 Hz tuning fork in Rinne test. The results of the study call for the necessity of early ENT observation of all the patients who are subjected to explosive trauma because the ear is particularly susceptible to damage