Perioperative morbidity and mortality in 100 cases of transhiatal esophagectomy- a single surgical unit experience of Khyber teaching hospital, Peshawar

To observe the perioperative morbidity and mortality rates of 100 transhiatal esophagectomies operated for esophageal carcinoma in a surgical unit of a tertiary care hospital. Data pertaining to all patients that had undergone transhiatal esophagectomy from Feb, 2012 to Jan, 2014 were reviewed. The study group comprised 100 patients. Indication for surgery was esophageal cancer. Perioperative morbidity and mortality i.e. morbidity and mortality during the first 30 days, were studied. Two patients died during the postoperative period in hospital. The anastomotic leakage rate was zero. No dysphagia was found during one month of postoperative period. Overall survival was 98% for the first 30 days of surgery. Transhiatal esophagectomy has been common stay and a safe rather feasible procedure. Oncological therapy has its role and better results are found in centers where the procedure is frequently performed

Clinical efficacy of herbal coded formulation Ocucure for the improvement of presbyopia: a randomized comparative clinical trial

A progressively diminishing capacity of eye to visualize for close proximity increasing by age is known as presbyopia which is usually resulted due to loss of elasticity of crystalline lens. A clinical trial was conducted to evaluate the efficacy of coded herbal formulation "ocucure" [Test drug] for the treatment of presbyopia comparing with leutivit [Placebo]. One hundred and eleven patients suffering from presbyopia from both groups [Males: 63, mean age: 34 +/- 14 and females: 48, mean age: 33 +/- 13 year, range: 20-60] were enrolled in the trial and divided in to two groups according to treatment regimens. Ocucure [Test drug] 500mg two tablets and leutivit [Placebo] 250mg tablets twice daily were prescribed for 6-8 weeks. Presbyopia was improved in 17 patients [28.81%] out of 59 patients by the use of ocucure [Test drug], and in 6 patients [11.53%] out of 52 by the use of leutivit [Control drug]. Furthermore, there was a significant improvement in presbyopic associated clinical features as compared to leutivit. It is concluded that ocucure possesses a therapeutic value for the improvement of presbyopia and its associated symptoms as compared to leutivit

Tube thorocostomy: management and outcome in patients with penetrating chest trauma

Penetrating chest trauma is common in this part of the world due to present situation in tribal areas. The first line of management after resuscitation in these patients is tube thoracostomy combined with analgesia and incentive spirometry. After tube thoracostomy following surgery or trauma there are two schools of thought one favours application of continuous low pressure suction to the chest tubes beyond the water seal while other are against it. We studied the application of continuous low pressure suction in patients with penetrating chest trauma. This Randomized clinical controlled trial was conducted in the department of thoracic surgery Post Graduate Medical Institute Lady Reading Hospital Peshawar from July 2007 to March 2008. The objectives of study were to evaluate the effectiveness of continuous low pressure suction in patients with penetrating chest trauma for evacuation of blood, expansion of lung and prevention of clotted Haemothorax. One hundred patients who underwent tube thoracostomy after penetrating chest trauma from fire arm injury or stab wounds were included in the study. Patients with multiple trauma, blunt chest trauma and those intubated for any pulmonary or pleural disease were excluded from the study. After resuscitation, detailed examination and necessary investigations patients were randomized to two groups. Group I included patients who had continuous low pressure suction applied to their chest drains. Group II included those patients whose chest drains were placed on water seal only. Lung expansion development of pneumothorax or clotted Haemothorax, time to removal of chest drain and hospital stay was noted in each group. There were fifty patients in each group. The two groups were not significantly different from each other regarding age, sex, pre-intubation haemoglobin and pre intubation nutritional status. Full lung expansion was achieved in forty six [92%] patients in group I and thirty seven [74%] in group II. Partial lung expansion or pneumothorax was present in three [6%] in group I and 10 [20%] in group II. One patient in group I and three [6%] patients in group II had no response. The mean time to removal of chest drains were 8.2 +/- 3.14 days in group I and 12.6 +/- 4.20 days in group II. The length of hospital stay was 7.2 +/- 2.07 days and 12.4 +/- 3.63 days in group I and II respectively. Clotted Haemothorax requiring surgery developed in three [6%] patients in group I and 8 [16%] patients in group II. Placing chest tubes on continuous low pressure suction after penetrating chest trauma helps evacuation of blood, expansion of lung and prevents the development of clotted Haemothorax. It also reduces the time to removal of chest drains, the hospital stay and the chances of surgery for clotted Haemothorax or Empyema

experience of 108 cases of esophagectomy using left thoracolaparotomy and cervical anastomosis with feeding jejunostomy, without gastric drainage procedure

Objective: To study efficacy and safety of esophagectomy using left thoracolaparotomy and left neck anastomosis with feeding jejunostomy, but no gastric drainage procedure

Design: An observational descriptive study

Place and Duration: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from June 2002 to September 2004

Subjects and Methods: Computerized clinical data of 108 surgically treated patients during twenty eight months was retrospectively analyzed. Detailed scrutiny of record was carried out to determine the suitability and safety of the surgical procedure and surgical outcome

Results: A total of 108 patients underwent esophagectomy through left thoracolaparotomy and left neck incision. Male: Female was 72: 36, age range was 18 - 72 years with a mean age of 42.3 years. The predominant clinical presentation was dysphagia. Tumor level was upper third of thoracic esophagus in 3 [2.7%], middle third in 48 [44.4%] and lower third in 57 [52.7%] patients. Tumor histology was squamous cell carcinoma in 72 [66.6%] and adenocarcinoma in 36 [33.3%] patients. The mean operative time was 155 [25 +/- ] minutes. Postoperative morbidity was 19.4% [21/108]. The complications were anastomotic leak in 7[6.5%], Hoarseness in 6[5.5%], aspiration in 3[2.7%]; reopening in 1[0.9%] and stricture in 4[3.7%] patients. The overall mortality was 8.3% [9/108]. Deaths were due to anastomotic leak in 3[2.7%] tracheal injury in 2[1.85%], respiratory failure in 2[1.85%] and pulmonary embolism in 2[1.85%] patients. 28 patients were lost to follow-up while incisional hernia was seen in 1, hoarseness in 3 and stricture in 3 patients over a last one month to 2 years follow-up. Recurrence occurred in 3/108 [2.77%]; one developed malignant ascities, after 4 months, one developed nodule in hypopharynx after 18 months, and one developed a subcutaneous nodule on the back after 14 months

Conclusion: Left thoracolaparotomy and cervical anastomosis is a safe approach for carcinoma of the esophagus. A 30 day mortality of 8.3% in a large series of 108 oesophagectomies with 2.7% recurrence and 19.4% morbidity speak volumes for the technique. Omitting a gastric drainage procedure does not adversely effect the outcome, while routine placement of a jejunostomy feeding catheter is a safe and cost effective mode of nutrition. Neck anastomosis gives a generous tumor free margin, a s a 11 except one resection margin was free o f tumor. T his i s further consolidated by only 3 cases of recurrence out of 80, with 28 being lost to follow up

Pneumonectomy for benign lung disease

Objective: This study was done to define morbidity and mortality of elective pneumonectomy for benign lung disease, as well as to recommend safety measures

Design: An observational descriptive study

Place and Duration of study: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from June 2002 to September 2004

Material and Methods: Thirty six patients received elective pneumonectomy. Male : Female 21 : 15. Age range was 4 months to 72 years. Past recurrent or new pulmonary tuberculosis was seen in 33/36 patients. Thirty one patients had chronic hemoptysis, while 6 had massive hemoptysis while thirty two had end stage destroyed lung. Left Right ratio was 24: 12. Double lumen endotracheal tube was used in 32 cases. Standard transpleural pneumonectomy was done in all cases with slight head down tilt of the table. Bronchial closure was done in 2 layers with interrupted Prolene 2/0 and 4/0. Single unclamped chest drain was put in all cases and removed after 24 hours

Results: Thirty day mortality was 1/36 [2.7%]. Morbidity included post pneumonectomy BPF 2, post pneumonectomy empyema 3 and wound infection 1. Both bronchopleural fistula and post pneumonectomy empyema were treated by tube thoracostomy initially, while 2 patients subsequently required additional thoracostoma and later space closure. Of these 1 went on to have thoracoplasty

Conclusion: Pneumonectomy proved effective therapy for end stage destroyed lungs with active / recurrent hemoptysis, but post pneumonectomy empyema and BPF are serious complications. Early clamping of the bronchus and avoiding bearing of bronchus reduce morbidity. There is no need to clamp the chest drain, which should be removed after 24 hours