Hepatic artery aneurysm: a rare cause of obscure upper gastrointestinal bleeding

Hepatic artery aneurysms are rare and represent 0.01-0.2% of all arterial aneurysms. The patient may present with abdominal pain, which may be associated with a mass. More acutely, patients present with signs of hypovolemia secondary to rupture of the aneurysm. The patient reported here presented with right upper abdominal pain and gastrointestinal hemorrhage of unknown etiology. A CT angiogram showed presence of hepatic artery aneurysm. Aneurysm was excised at laparotomy.

Increased risk of carcinoma gall bladder in longstanding cases of cholelithiasis

To find out the incidence of carcinoma of gall bladder in longstanding cases of Cholelithiasis with history of more than 5 years. A prospective observational clinico-pathological study. Departments of surgery, Nawabshah Medical College Nawabshah. From March 2000 to Feb: 2005. Total 180 cases were included in the study among all the 520 cholecystectomies performed during this period, which were symptomatic proven cholelithiasis cases for past 5 years or more. Most patients were from rural area with urban rural ratio 30:70. All the specimens of removed gall bladder were examined histologically. Female to male ratio was 4:1 and age incidence was 5 1-72 years. Out of 180 cases included in the study 12 [6.6%] patients were of carcinoma of gall bladder with female to male ratio 3:1 and peak age incidence was 65 years. The longer duration of disease with gall stones increases the risk of carcinoma in gall bladder. The patient diagnosed cholelithiasis should be counseled for early operation and all the specimens of removed gall bladder should be examined histopathologacally

Retroperitoneal lymphangioma

Retroperitoneal lymphangioma is a rare benign congenital malformation of lymphatic channels. This report is of a 35 years old male who presented with 1 month history of abdominal pain and swelling due to a large retroperitoneal cystic lymphangioma. The lesion was removed surgically with complete resection

Pleomorphic rhabdomyosarcoma within a choledochal cyst; a rare cause of obstructive jaundice

Bile duct cysts are rare and of uncertain origin. Most have been reported in young females of Asian Descent. The long term complication of choledochal cysts includes malignant transformation in the epithelial lining of biliary tree. Histopathologically it is Cholangiocarcinoma in the majority of cases with poor long-term prognosis. However, Rhabdomyosarcoma associated with choledochal cyst in an adult is rarely reported before. The authors report one such case in an adult female patient who presented to us with features of obstructive jaundice

study of gynaecological emergencies presenting as Acute Appendicitis

To assess the frequency of gynaecological emergencies presenting as acute appendicitis among females of child bearing age. Descriptive analytical study. The study was conducted at the surgical unit-II of Sheikh Zayed hospital and postgraduate medical institute Lahore from January 2000 to December 2000. The study included 105 female patients aged 15-45 presented in accident and emergency department with right iliac fossa pain. Diagnosis was clinical in all cases .Investigations for leukocyte count, pregnancy test and lower abdominal ultrasound scan were used to improve diagnostic accuracy. All diagnosed patients underwent appendectomy and intra-operative findings were recorded. Patients with gynaecological disorder were dealt accordingly. Final diagnosis of acute appendicitis was made on Intra-operative findings and histopathology report. There was high frequency of gynaecological disorders simulating acute appendicitis in the age group ranging 15-25 years with mean age 23.1 and standard deviation + 0.74. Duration of pain ranges from 12 hours to 4 days. Pain and tenderness in right iliac fossa was found in all patients where as shifting of pain was present in 61% of cases. Total leukocyte count more than 11000 per cubic millimeter was present in 60% cases. Peroperatively acutely inflamed appendix was found in 71.4% ruptured ovarian cyst in 11.4%, right tubal abortion in 0.9% and pelvic inflammatory disease in 4.7% of patients. Histopathological report revealed that in 77.1% of cases appendix was acutely inflamed. Thus out of 105 study subjects who underwent appendectomy, 18[17%] were having gynaecological problems. In 3[2.8%] mesenteric lymph node biopsy was done, which turned out to be chronic nonspecific inflammation. In 9[8.5%] no positive finding could be found preoperatively. The rate of negative appendectomy in our study was 22.9%. There is considerable number of young females with gynaecological disorders presen ting in emergency as acute appendicitis. Good clinical judgment and routine use of ultrasonography is desirable to reduce the negative rate

outcome of stomach pull up in the benign and malignant diseases of the esophagus

The objective of the study was to assess the outcome of stomach pull up in benign and malignant diseases of esophagus. This study was conducted between January 1998 to January 2001, at Shaikh Zayed Hospital and Sir Ganga Ram Hospital, Lahore to evaluate the results of "Stomach pull-up" in benign and malignant diseases of esophagus. This study included twenty-five patients both males and females of different ages. Seven patients formed the benign group and eighteen patients in malignant group. Barium studies, gastroscopy and biopsy and C.T scan were important investigation other than the routine ones. We followed Orringer`s technique in most cases of [Stomach Pull-up]. Results of study were encouraging. The incidence of pneumothorax was 40% and anastomotic leak was 30% and mortality rate of 10% which were comparable to those reported in literature. We optimistically conclude from this study that stomach "pull up" is a safe and simple procedure and we recommend it as a curative and palliative procedure for benign and malignant diseases of esophagus

Carcinoma of breast experience at sheikh Zayed hospital lahore

Breast carcinoma is a common malignancy in females. [1] To review the modes of treatment [2] To see the corelation of size of tumour with nodal spread DESIGN. Reterospective study SETTING: Sheikh Zayad Hospital Lahore PERIOD: Three years [Jun 1991 -Jun 1994] MATERIAL AND METHODS. 105 patients were studied 101 patients were females and 4 patients were males. Various modes of surgery were noted. Post operative adjuvant therapy, hormone manipulation, radiotherapy and chemotherapy were noted. Mean age was 45,6 years. infiltrating ductal carcinoma was seen in 86.64% patients left breast involvement was 54.28% right breast involvement was seen in 42.85% cases. Mean lymph node invoivemny was 11 and5.24% cases were diagnosed in early ivasive stage [T[2] N[1]M0] CONCLUSIONS: Modified radical mastectomy provides good loco regional control of the disease, adjuvant therapies help to take care of possible spread of tumour