Hepatitis B and C virus infection in surgical practice

Objective: To determine frequency of hepatitis B and C virus infection in surgical patients and its relation to already reported risk factors

Study design: Case series

Place and Duration of Study: Department of Surgery Civil Hospital Karachi, from May 2012 to September 2012

Methodology: All patients who were scheduled for surgical procedures were screened for HBsAg and anti-HCV using immunochromatography [ICT]. The variables already known for the possible transmission were also inquired. The data was entered into a Performa and entered into SPSS version 17. Descriptive statistics were used for computation of the results

Results: Out of the total 662 patients, 325 [49.1%] were males and 337 [50.9%] females. Mean age of patients was 37.52 year. Hepatitis B surface antigen [HBsAg] was positive in 19 [2.9%] patients of whom 12 [63.15%] were males. Hepatitis C [anti-HCV] was found in 45 [6.8%] patients of whom 24 [53.33%] were females. Among HBsAg positive patients, 17 [89.47%] had history of intravenous injections; similar history was found in 44 [97.77%] anti-HCV positive patients

Conclusions: Frequency of hepatitis B was slightly more than hepatitis C in surgical patients. Routine serological screening prior to surgery should be made mandatory so that health care workers especially surgeons can take precautions before surgery

Frequency and sensitivity of micro-organism in post-operative wound infections: a quest for microbes

To determine the frequency of common organisms involved in post- operative wound infection. To determine the sensitivity of micro-organism for different antibiotics. Prospective cross-sectional descriptive study. This study was carried out at Surgical Units of Civil Hospital Karachi from April to September, 2010. 72 swab samples were collected from patients who had undergone operations. Samples were obtained from the hospital and processed in Civil Hospital Karachi lab [Microbiology Department]. Out of 72 bacterial isolates found in post-operative wound infection, 30 [41.66%] were E.Coli, followed by Klebsiella species 14 [19.44%], pseudomonas aeruginosa 13 [1.38%], staphylococcus aureus 6 [9.72%], providential species 1 [1.38%], proteus mirabilis 1 [1.38%], Actinobacter 1 [1.38%] and no growth 6 [9.72%]. The result showed that the occurrence of infection was higher in the age group between 20 -40 than any other group. There is no significant difference between male and female sexes in the occurrence of infection. Infection was more in the operation done under emergency circumstance than the elective ones.There was no significant association between infection, and co-morbidities and past history of wound infection. The sensitivity pattern of 4 main bacteria, Frequently found in the study i.e. E.coli, klebsiella, pseudomonas aeruginosa and s.aureus isolates, suggested that the organisms were more sensitive to imipenem, Amikacin sulphate, Ceftazidime, Cefperazone/Sulbactum and Pipercillin/Tazobactum than other groups of drugs. The most common causative organism was E.coli, infection rate was higher among the patients operated in emergency and imipenem, Amikacin sulphate were found to be more sensitive

Frequency and sensitivity of micro-organism in post-operative wound infections: a quest for microbes

To determine the frequency of common organisms involved in post- operative wound infection. To determine the sensitivity of micro-organism for different antibiotics. Prospective cross-sectional descriptive study. This study was conducted in 3 Surgical Units of Civil Hospital Karachi from April to September 2010. 72 swab samples were collected from patients who had undergone operations in 3 Surgical Units of Civil Hospital Karachi during a period of 6 month from April to September, 2010. Samples were obtained from the hospital and processed in Civil hospital Karachi lab [Microbiology Department]. Out of 72 bacterial isolates found in post-operative wound infection, 30 [41.66%] were E.Coli, followed by Klebsiella species 14 [19.44%], pseudomonas aeruginosa 13 [1.38%], staphylococcus aureus 6 [9.72%], providential species 1 [1.38%], proteus mirabilis 1 [1.38%], Actinobacter 1 [1.38%] and no growth 6 [9.72%]. The result showed that the occurrence of infection was higher in the age group between 20 -40 than any other group. There is no significant difference between male and female sexes in the occurrence of infection. Infection was more in the operation done under emergency circumstance than the elective ones. There was no significant association between infection, and co-morbidities and past history of wound infection. The sensitivity pattern of 4 main bacteria, Frequently found in the study i.e. E.coli, klebsiella, pseudomonas aeruginosa and s.aureus isolates, suggested that the organisms was more sensitive to imipenem, Amikacin sulphate, Ceftazidime, Cefperazone/Sulbactum and Pipercillin/Tazobactum than other groups of drugs. The most causative organism was E.coli, infection higher among the patients operated in emergency and imipenem, Amikacin sulphate were found to be more sensitive

Role of diagnostic laparoscopy in recurrent vague abdominal pain

To determine the role of laparoscopy in the management of recurrent vague abdominal pain. Descriptive case series. Surgical Unit 1, Civil Hospital Karachi, from January 2005 to June 2007. All patients who presented with vague recurrent abdominal pain and underwent laparoscopic surgery to make a definitive diagnosis were included in the study. A total of 60 patients were managed. There were 36 [60%] females and 24 [40%] males. The mean age was 26 year [range 18-58 year]. The common mode of admission was out patient department [73.3%]. Fourteen [23.3%] patients presented with vague abdominal pain in lower Abdomen, followed by 12 [20%] with right lower abdominal pain and 12 [20%] with central pain radiating to right lower abdomen. Diagnosis was established in 56 [93.3%] patients. In 4 [6.6%] patients no pathology was found. The most common diagnosis was inflamed appendix in 18 [30%] patients followed by abdominal tuberculosis in 16 [26.6%] patients. Most [36.6%] of the patients stayed in hospital for 24 hours. There was no readmission and no major postoperative complications. Diagnostic laparoscopy in vague abdominal pain provided a higher diagnostic accuracy and improved treatment. It may be considered as first line operative investigation for undiagnosed vague abdominal pain

Non-hodgkin's lymphoma of the breast presenting as breast abscess during pregnancy

Primary non-Hodgkin's lymphoma of the breast is an uncommon disease. In all patients with breast lump, primary lymphoma of breast should be considered as it is one of the most easily missed pathology. We report a case of a 22 years old lactating mother who presented with the complaint of a painful swelling in the right breast, noticed during the last trimester of her pregnancy, mimicking breast abscess

Stapled hemorrhoidectomy in third degree hemorrhoids: a prospective study

To study the outcome of Stapled haemorrhoidectomy in 3rd degree hemorrhoids. 50 patients, who underwent stapled hemorrhoidectomy, were included in this study. The study took place at Surgical Unit-I, Civil Hospital, Karachi, from January 2009 to December 2010. Prospective interventional study. Stapled hemorrhoidectomy [SH] was performed in 3rd degree haemorrhoids in 50 patients. 3 patients had minimum pain and only 1 patient had persistent pain and one patient had post-operative minor bleeding which was managed conservatively. SH is an effective surgical procedure for the treatment of 3rd degree haemorrhoids. There is strong evidence that SH results in less postoperative pain than other procedures as well as earlier mobility. In our experience, SH is the treatment of choice for third degree hemorrhoids in hospitalized patients

Frequency of hepatitis B and C in pre-operative patients for elective surgery

Objective: to document frequency of Hepatitis B and C in patients undergoing elective surgery

Design: descriptive case series

Setting: surgical Unit II Civil Hospital Karachi, from June 2005 to May 2006

Methods: all patients undergoing elective surgery were screened for Hepatitis B and C by enzyme immunoassay [EIA]. Risk factors for hepatitis B and C virus infections were also recorded

Results: out of 496 screened patients, HBsAg was found positive in 25 [5.0%] patients. Out of 25 HBsAg positive patients 14 [56%] were females and 11 [44%] were males. Anti-HCV was reported positive in 60 [12.0%] patients in which 38 [63.3%] were females and 22 [36.6%] were males. Overall 19.7% subjects had been vaccinated against HBV

Conclusion: we conclude that the high prevalence of hepatitis B and C in pre-operative patients is present in our population

Prevalence of malignancy in resected specimen of patients operated for benign nodular goitre

To determine the frequency of malignancy on histopathology amongst resected specimen of thyroid gland in patients, who had no evidence of malignancy pre-operatively on clinical grounds and investigations. A retrospective descriptive study carried out from Jan. 2000 to Dec. 2005. Surgical Unit one, Civil Hospital, Karachi. A total of 190 patients who were operated for benign nodular thyroid disease during the study period; 100 cases had multinodular goitre and 90 solitary nodules. Biodata, clinical features, investigations, diagnosis, details of surgery, complications and histopathology reports of all the patients were reviewed and analyzed. Amongst the 190 patients the mean age was 33.42 +/- 12.4 years [range l7-45 years], while the male: female ratio was 1:6.6. Seven [3.6%] cases were found to be malignant on histopathology, with a frequency of 3% [3/100] amongst multinodular cases and 4.4% [4/90] amongst solitary nodules. Prevalence of malignancy in multinodular goiter does not differ significantly from solitary nodules. Hence, multinodularity should no longer be considered as an indicator of benign disease. Both varieties of nodular goitres should be considered for surgery even if there is no suspicion of malignancy

Five years experience of carcinoma breast

To evaluate the presentation, staging and histology of carcinoma breast patients admitted over a period of five years A retrospective analytical study was conducted at surgical unit two, Civil Hospital Karachi over a period of five years from October 2001 to October 2006. Eighty five female patients with biopsy proven carcinoma breast admitted and operated, were included in the study. 43.5% patients were under the age of 45 years. 4.7%had family history, 49.4%were premenopausal, none had history of oral contraceptive intake. 84.7% had breast fed their siblings, 12% were nulliparous. 29.4% had skin involvement at presentation; nipple retraction was seen in 23.5%. 90.5% had infiltrating ductal carcinoma with 58.8% having histological involvement of axillary lymph nodes. 50% had stage 3 and 41% stage 2 cancers. The risk / predisposing factors for carcinoma breast were not significantly present in our study population. Most of the patients at presentation had stage two and three carcinoma, with the predominant cancer type being infiltrating ductal carcinoma

Comparison of preoperative ultrasonographic findings with operative finding in hepatobiliary surgery

To compare preoperative ultrasonographic findings with operative findings in hepatobiliary surgery. Design and Place of study: A descriptive study was conduced at Unit II, Dept. of Surgery, CHK. Place and Duration: The study was conducted in Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Centre, Karachi, Pakistan between February, 2000 to January, 2004. Patient And Hundred patients admitted over a period of two years from January, 2002 to December 2003, for hepatobiliary diseases were included in the study. Ultrasonography for their basic problem was done. All these patients underwent surgery. Operative findings were compared with preoperative ultrasonography findings and the accuracy of ultrasonography in hepatobiliary diseases was evaluated. In 34 cases, ultrasonographic findings as compared to operative findings were inaccurate while in 55 patients these were comparable to operative findings. Generally accepted overall accuracy rate of ultrasonography in hepatobiliary diseases is 86%. Accuracy rate in this study was only 66% showing that ultrasonography is an operator dependant procedure

Prevalence of intestinal tuberculosis amongst cases of bowel obstruction

Intestinal obstruction is a common problem which presents in the surgical wards usually as an emergency. The objective of this study was to determine the prevalence of tuberculosis as a cause amongst cases of intestinal obstruction. In this retrospective study carried out in 2003, 50 patients [38 males, 12 females] were admit-ted in Surgical Unit II of Civil Hospital, Karachi with the diagnosis of intestinal obstruction. Their age and sex was noted along with significant findings in the history and examination, operative findings and the subsequent treatment. Out of these patients, 36 [72%] had intestinal tuberculosis. The study further showed that about 80% of the tubercular patients had obstruction in the terminal ileum. The diagnosis of intestinal tuberculosis was not easy because there are no specific signs and symptoms

Incidence of abdominal tuberculosis presenting with intestinal obstruction

A retrospective study of 27 patients presenting with intestinal obstruction, with a strong suspicion of abdominal tuberculosis on admission was carried out at the surgical unit-3, Civil Hospital, Karachi, during the period of 15 months, from October '99 to December '2000. 20 patients [74 percent] were admitted through the emergency department. Among them 16 [59.2 percent] were females mostly in the 20- 40 age group and 11 [40.7 percent] were males in the 30 to 50 age group. Of the 27 cases 9 were known cases of abdominal tuberculosis on admission. 4 cases [14.8 percent] responded well on conservative management on anti-tuberculous therapy, all of the remaining 23 cases [85.1 percent] underwent surgical intervention. Of these 22 cases were provisionally diagnosed as Abdominal Koch's; the criteria of which were based on clinical presentation, laboratory investigations, and radiology and per-operative findings. The most common operative finding was of the multiple strictures of the small bowel. Out of 23 patients operated for acute intestinal obstruction, 17 cases [73.9 percent] were finally diagnosed as abdominal tuberculosis on histopathology. Segmental resection, bypass procedures, and right hemi-colectomy were the common operative procedures, performed on these patients. Abdominal tuberculosis can be difficult to diagnose pre operatively and thus a delay can affect the proper management and increase the morbidity. So an early diagnosis can make a difference in the prognostic outcome

Incidence of helicobacter pylori associated chronic antral gastritis in patients presenting with dyspeptic symptoms at Sindh Govt. Lyari general hospital

Recent Studies have proved that H. Pylori, found in gastric Antrum of patients with peptic ulcer disease, is now believed to have a pathophysiologic role in Gastritis. Aim of the study was to observe and detect during routine upper G.I. Endoscopic carried out at the S.GLyari Gen. Hospital, in patients presenting with dyspepsia, the incidence of H. Pylori, confirmed by Antral Biopsy method for Urease test or histopathology.diagnostic Upper G.I. Endoscopics were performed on 61 patients presenting with Dyspepsia in the period of 18 months from February '98 to August'99. Routine Antral Biopsies were taken in all patients, in all patients, in which gastritis was seen and urease test done all of them, and biopsy was also sent for Histopathology. Out of the 61 Endoscopies done on patients presenting with symptoms of Dyspepsial Epigastric pain, 30 patients had Antral gastritis [17 were H.Pylori+ve and 13 were H.Pylori-ve], 19 were essentially normal, 02 had duodenal ulcer. Triple Regime Treatment, comprising Omeprazole, Clarithromycin and Amoxicillin was given to H.Pylori+ve patients for two weeks and of these 73.3% responded very well. Incidence of aprox. 56.6% H.Pylori associated chronic Gastritis was observed. The diagnostic methods of upper G.I.Endoscopies plus antral biopsies for HelicoUrease test/Histopathology have high specificity and sensitivity

Incidence of carcinoma of gallbladder discovered on routine histopathology after cholecystectomy for cholelithiasis

This is a retrospective study of 148 patients, seeking for incidence of carcinoma of gallbladder in patients admitted with cholelithiasis in Surgical unit-3, Civil Hospital Karachi, form January 1999 to 2001, all of whom underwent cholecystecomy. Out of 148 patients, 120 [81%] were females [mean age 40 years], 14 [9.4%] were males [mean age 56 years]. The commonest clinical presentation was of upper abdominal pain [93%], followed by flatulent dyspepsia [65%], nausea and vomiting [25%], and palpable gallbladder [17%], jaundice [14%]. Live function tests were altered in 21% of cases, with raised alkaline phospatase in 17%. Utraonography of abdomen was done in all the patients, which showed choleithiasis in 100% of cases, increased wall thickness [7%], irregularity in the wall [4%], CBD dilatation with or without stones in 16% of cases. Laparoscopic Cholecystectomy was done in 72 patients and open cholecystectomy was done in 65 patients. 16 patients had CBD exploration. 08 patients were suspected of carcinoma gallbladder per-operatively. Cholecystectomy plus wedge resection of liver was done in 05 patients and the other 03 suspected cases had simple cholecystectomy. Histopathology of all the above patients revealed inflammatory changes in 138 patients [93%], 10 patients [7%] were diagnosed as stage-I carcinoma of gallbladder on histopathology. Of these 06 came bock for follow up, and no further surgical intervention was offered and treatment was expectant and symptomatic. The incidence of carcinoma discovered on routine histopathology after cholecystectomy for choleithiasis with chollecystitis was 7%

Two dose prophylactic antibiotic-role in prevention of wound infection in clean and clean contaminated surgical wound

This prospective study was carried out in surgical unit 7 Dow Medical College and Sindh Government Lyari General Hospital Karachi from September 1997 to July 1998. Thirty patients belonging to different surgical problem were included. Diabetic and immunodeficientpatients were excluded from study. Patient age ranged between 2-70 years. Mean duration of operation was 40 minutes. One patient [3.3%] developed deep wound infection in clean surgical would and needed restarting of antibiotics. However, results of two dose first generation cephalosporins as prophylactic antibiotics are encouraging even in hospitals situated in neglected areas of metropolitan city like Sindh Government Lyari General Hospital Karachi