Outcome of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy for patients with acute cholecystitis

Background: This prospective randomized study was undertaken to to assess the outcomes of early versus delayed cholecystectomy for patient’s acute cholecystitis.Methods: 70 patients with acute cholecystitis were prospectively randomized to either an early laparoscopic cholecystectomy (n=35) or a delayed laparoscopic cholecystectomy group (n=35). The mean operative time, conversion rate, total hospital stay, intra-operative and post-operative complications, average hospital cost were evaluated between the two groups.Results: A total of 70 patients were enrolled, 35 patients in each group. There was no significant difference in the conversion rates (early, 8.57% vs delayed, 5.71%) and postoperative complications (early, 25% vs delayed, 20%). At the cost of an increased operating time (early, 81 minutes vs delayed, 78 minutes) and blood loss (early, 180.33ml vs delayed, 108.00 ml), early laparoscopic cholecytectomy significantly shortened the total hospital stay (early, 1.5 days vs. delayed, 7.95 days) and  average hospital cost (early 9240 INR vs delayed, 12251 INR).Conclusions: The safety and efficacy of early and delayed laparoscopic cholecystectomy for acute cholecystitis were comparable in terms of morality, morbidity and conversion rate. However early laparoscopic cholecystectomy allows significantly shorter  total hospital stay and reduction in days away from work at the cost of  longer operating time and blood loss and offers definitive treatment at initial admission. Moreover it avoids repeated admissions for recurrent symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.

The effect of propofol when injected at different speeds for induction of general anesthesia: an observational study

Background:The hypotensive effect of propofolis attributable to a decrease in sympathetic activity,direct vasodilatation and myocardial depression. The aim of the study wasto assessthe effect of propofol when injected at different speeds for induction of general anesthesia on the following parameters:blood pressure,time of induction of anesthesia,dose of propofol used.Methods:The present study was conducted in post Graduate Department of Anesthesia and Surgery, Govt. Medical College,Srinagar for a period of two years and included 90 patients from July 2014 to June16,the study was prospective one.Results:In our study patients divided into three groups with 30 patients in each group.The mean age in group P400,P600,P800 wasstatistically insignificant p>0.843.The mean weight in group P400, P600, P800 was statistically insignificant p>0.885.The mean height in group P400,P600,P800 was statistically insignificant p>0.748.The mean induction time in P400 and in P600 was statistically significant.The mean systolic blood pressure, pre and post induction in P400,in P600 and in group P800 was statistically significant. The mean diastolic blood pressure, in pre and post induction in P400,P600,P800 was statistically insignificant with a p>0.05.The mean arterial pressure in pre and post induction in P400,P600,P800 was statistically significant (p<0.05).The mean heart rate in pre and post induction was statistically insignificant. The mean oxygen saturation (%) pre and post induction was statistically insignificant. Conclusions: We concluded that induction dose required for loss of consciousness increased with a faster rate of infusion while time for induction was shorter in P800 compared to P400 and P600, and the decrease in mean blood pressure was less after induction in P400.Propofol injection should be slow enough to prevent any hemodynamic deterioration in anesthesia induction

Histopathological evaluation of odontogenic keratocysts and radicular cysts in Peshawar

Odontogenic cysts are jaw lesions that may be misdiagnosed due to lack of complete data. Clinical, radiographic and histopathological correlation is required for the diagnosis of these cysts. The study was thus designed to determine frequency and compare the histopathological features of radicular cysts and odontogenic keratocysts in population of Northern Pakistan. The study was conducted at Sardar Begum Dental College and Khyber College of Dentistry, Peshawar. Non-probability, consecutive sampling technique was used to select 70 cases of odontogenic cysts from 190 cystic jaw lesions. Formalin-fixed paraffin-embedded tissue samples of Odontogenic keratocysts [n=22] and radicular cysts [n=48] were retrieved from the archives of Khyber College of Dentistry and Sardar Begum Dental College, Peshawar. Frequencies of the cysts were calculated. These were then evaluated for histopathological variables which included thickness of epithelial lining, keratinization, foamy macrophages, mucous cells, Rushton bodies, cholesterol crystals and haemosiderin. Chi-square test/ Fishers exact test was applied to compare cysts. The data was analyzed using SPSS version 21. Frequency of the radicular cyst and odontogenic keratocyst was 68.5% [48N] and 31.5% [22N] re-spectively. The histopathological features showed presence of mucous cells, vacuolated cells, spongiosis, micro-abscesses, cholesterol crystals, hemosiderin and inflammatory infiltrate. The radicular cyst was the most prevalent in our study 48[68.5%], followed by the odontogenic keratocysts 22[31.5%]. The histopathological features observed in these cysts are comparable with other populations of Pakistan and abroad

Frequency of p53 gene mutation and protein expression in oral squamous cell carcinoma

To determine the frequency of p53 gene mutation and protein expression in Oral Squamous Cell Carcinoma [OSCC] and to establish correlation between the two. Analytical study. Histopathology Department and Molecular Biology Laboratory, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from May 2010 to May 2011. Thirty diagnosed cases of OSCC were selected by consecutive sampling. Seventeen were retrieved from the record files of the AFIP, and 13 fresh/frozen sections were selected from patients reporting to the Oral Surgery Department, Armed Forces Institute of Dentistry [AFID]. Gene p53 mutation was analyzed in all the cases using PCRSSCP analysis. DNA was extracted from the formalin-fixed and paraffin-embedded tissue sections and fresh/frozen sections. DNA thus extracted was amplified by polymerase chain reaction. The amplified products were denatured and finally analyzed by gel electrophoresis. Gene mutation was detected as electrophoretic mobility shift. The immunohistochemical marker p53 was applied to the same 30 cases and overexpression of protein p53 was recorded. Immunohistochemical expression of marker p53 was positive in 67% [95% Confidence Interval [CI] 48.7 - 80.9] of the cases. Mutations of the p53 gene were detected in 23% [95% CI 11.5 - 41.2] of the OSCC. No statistically significant correlation was found between p53 gene mutation and protein p53 expression [rs = - 0.057, p = 0.765]. A substantial number of patients have p53 gene mutation [23%] and protein p53 expression [67%] in oral squamous cell carcinoma [OSCC]

Alterations of P53 [gene mutation and protein expression] in oral epithelial dysplasia

Oral Squamous Cell Carcinoma [OSCC] is usually preceded by precancerous lesions. These lesions appear white or red clinically [Leukoplakia and Erythroplakia respectively] and show dysplastic epithelial changes on histopathological examination [Abbas et al, 2007]. If p53 alterations [gene mutations and protein expression] in premalignant lesions are detected and treated in their early stages, it might help in prevention of progression to cancer [Patton et al, 2008]. Aim was to determine the frequency of p53 gene mutation and protein expression in oral epithelial dysplastic lesions. This was a descriptive study carried out at the Armed Forces Institute of Pathology [AFIP], Rawalpindi and was of one year duration from 8[th] May 2010- 5[th] May 2011. Thirty cases of oral epithelial dysplasia [OED] were retrieved from the record files. Some fresh /frozen sections were also included. Gene p53 mutation was detected in these cases by PCR-SSCP Analysis. DNA was extracted from the formalin-fixed and paraffin-embedded tissue sections and fresh /frozen sections. DNA thus extracted was amplified by polymerase chain reaction. The amplified products were denatured and finally analyzed by gel electrophoresis. Gene mutation was detected as electrophoretic mobility shift. The immunohistochemical marker p53 was applied to the same 30 cases andproteinp53 expression was recorded. Mutations of the p53 gene were detected in 20% of the dysplastic lesions. Immunohistochemical staining ofmarkerp53 was positive in 60% of the cases. Gene p53 mutation and protein expression was not coexistent

E-cadherin expression, a valuable predictor of invasiveness in histological grades of oral squamous cell carcinoma

The aim of this study was to evaluate E-Cadherin expression in oral squamous cell carcinoma [OSCC] with its relation to histological grades. It was a quasi experimental study in which sixty diagnosed cases of oral squamous cell carcinoma were selected by purposive sampling technique. Fresh sections were prepared and re-diagnosed for relative histological grades by H and E staining, regardless of their previous diagnosis. E-Cadherin expression was assessed in terms of Intensity and Site of staining and its expression was recorded. The collected data were analyzed by SPSS version 17. The differential grades observed in 60 cases both with H and E and E-Cadherin staining methods were compared which showed a highly significant association, P-value < 0.001. A strong membranous E-Cadherin expression was observed in cells of well differentiated squamous cell carcinoma, which changed to heterogeneous [both membranous as well as cytoplasmic expression] in moderately differentiated SCC and became weak cytoplasmic to absolute negative in poorly differentiated OSCC. Intensity of E-Cadherin expression was also observed to be reduced, P-value < 0.001, with the advancing histological grades of oral squamous cell carcinoma. It was concluded that E-Cadherin expression provides accurate details of tumour behaviour at all levels in a given section which can be used to predict the prognosis of the disease more accurately

Immunohistochemical expression of protein p53 in oral epithelial dysplasia and oral squamous cell carcinoma

The study was carried out to determine the frequency of p53 protein expression in oral dysplastic lesions and oral squamous cell carcinoma and to compare them in both the lesions. Sixty cases [30 each] of oral epithelial dysplasia [OED] and oral squamous cell carcinoma [OSCC] were retrieved from the record files along with their paraffin blocks at the Armed Forces Institute of Pathology, Rawalpindi including twenty fresh/frozen sections. The immunohistochemical marker p53 was applied using Streptavidin-Biotin technique. Staining and intensity of the marker was recorded and frequencies were compared in both the lesions. Protein p53 expression was seen in 60% of oral epithelial dysplastic lesions and 67% of oral squamous cell carcinomas. The results signify the importance of p53 for the early diagnosis and early treatment of dysplastic [precancerous] lesions

Ameloblastomas - seven years clinical audit

To determine the pattern and presentations of ameloblastoma in patients reporting to Armed Forces Institute of Dentistry [AFID], a descriptive study was undertaken from June 2002 to June 2009. A total number of 34 Ameloblastoma patients who were treated at the institute were analyzed. Their mode of presentation, site involved, various age groups and gender distributions, histological patterns, clinical and radiological features, treatment offered and follow up was recorded. The age range was from 15 to 65 years with mean age of 37.6 years. Out of 34 patients, 24 [70.6%] were males and 10 [29.4%] were females. Majority of tumours, 28 [82.3%] were present in mandible and the most common site was angle of the mandible 13[38.2%]. Clinically most common feature was swelling without pain and was experienced by 19 [55.9%] patients. Radiographically, there were 19 [55.9%] patients with multilocular radiolucency and 11 [32.4%] patients with unicystic appearance while 4 [11.8%] patients had typical honeycomb appearance. The most common histological pattern was follicular, seen in 21 [61.8%] patients. Enucleation with curettage was carried out in most of the cases 11 [32.4%], marginal resection was done in 10 [29.4%] cases, segmental resection was performed in 7 [20.6%] patients and radical resection with reconstruction was done in 6 [17.6%] patients. Ameloblastoma is one of the most common odontogenic tumour mostly occur in lower jaw. It is locally invasive and have high rate of recurrence therefore early diagnosis, complete excision with safe margins followed by reconstruction and long term follow up is required for psychological and emotional well being of the patient