Surgical site infection; evaluation of causative organisms involved

Wound infection can be defined as invasion of organisms through tissues following a breakdown of local and systemic host defenses. The basic principles of wound care and antisepsis introduced during the past century improved surgery dramatically. Evaluation of causative organisms which evolved in the surgical site infection [elective abdominal surgery] at surgical unit of Liaquat university hospital Jamshoro. This prospective observational study was contains 103 patients undergoing elective, abdominal surgery were included in this study. Surgical wound categories i.e. clean, clean contaminated, were included. Prophylactic antibiotics were given in all cases. Primary closure of wounds was employed in all cases. Follow up period was 30 days postoperatively. All cases were evaluated for postoperative fever, redness and swelling of wound margins, collection and discharge of pus. Cultures were taken from all the cases with any of the above findings. The mean age of the patient was 37 years with male to female ratio of 1:5:1. The overall rate of wound infection was 13.04%. Most frequently involved pathogen was E.col 33.33% followed by Staph Aureus 20%, Klebsiella 20%, proteus 13.33%, Pseudomonas 6.66% and no organism was isolated in 6.66% cases. Most effective antibiotics were cephalosporins, quinolones and aminoglycosides' whereas septran, erythromycin and tetracycline's were ineffective. Surgical wound infections are quite common. Time of postoperative hospital stay was twice longer in infected case. Male sex, old age, anemia, longer duration of operation and wound class were significant risk factors. Most common organims are found in this study E-Coli, Kllebcella and Staph Aureus, these are mostly sensitive to cephalosporins, quinolones and aminoglycosides

Current pattern and diagnosis of small bowel obstruction in the patients of rural areas

Objective of this study to determine the clinical presenting factors including diagnosis and risk factors of the patients those admitted with small bowel obstruction. Observational study. This study was carried out at the Departments of General Surgery, Peoples Medical University and Health Science Nawabshah and Isra University Hospital Hyderabad from March 2013 to Aug 2013. After admission detailed history, physical examination, ultrasound, X-ray abdomen erect and supine and all routine baseline laboratory investigations were carried out. CT scan was done in the selected patients. Final diagnosis was done by laparotomy which was attempted after thorough initial assessment and investigations. Total 50 patients were included in the study of the rural areas of the Sindh, from all of them male were in majority. On the clinical presenting features Nausea, Constipation and Abdominal pain were most common with the percentage of 92%, 80% and 78% while other presenting features as; Vomiting, Abdominal tenderness, Abdominal distension, Fever, Epigastrium pain, Rectal bleeding and Rebound tenderness were with the percentage of 40%, 42%, 22%, 38%, 30%, 16%, 10% and 26% respectively. On the diagnosis adhesion was found as most common. In the conclusion of this study adhesion found as most common and leading cause of small bowel obstruction

Causes and management out come of peritonitis

This retrospective study was conducted to study the different causes of peritonitis and to determine the surgical outcome. Retrospective study. This study was carried out at the Department of Surgery Peoples Medical College Hospital Nawabshah from 1[st] January 2001 to 31[st] December 2001. In this study of 51 patients of peritonitis admitted, out of them, 16 cases of typhoid ileal perforation, 8 cases of perforated duodenal Ulcer, 7 cases of tuberculosis of those 2 cases were of jujenal perforation and 5 cases of ileal perforation, 4 cases of perforated appendix, 4 cases of ruptured liver abscess, 2 cases of perforated neoplasms of those 1 case each with multiple ileal/ jujenal perforation due to lymphoma ,malignant caecal perforation, gastric perforation, jujenal perforation obstructive/strangulated, infective caecal perforation each, 2 cases of post operative peritonitis, 3 cases trauma, 2 cases of blunt abdominal trauma each developed peritonitis due to ileal and jejunal perforation, 1 case of gunshot injury causing peritonitis due to colon perforation, 2 cases of ruptured ovarian cyst associated with appendicitis. In our study, male to female ratio is 4:1. Maximum frequency was observed in 20-30 years age, whereas most of the patients ranged between 13 to 40 years. Surgical outcome of the peritonitis resulted poor in those cases who came late with hugely contaminated peritoneal cavity when operated. They developed post operative complications i.e. wound infection, septicemia, fecal fistula and longer hospital stays. 22 patient's outcome was poor and out of them 8 patients expired. The mean hospital stay was 23.0 +/- 17.7 days and the range was 67[3-110 days]

experience of open Anderson-Hynes pyeloplasty

To document the outcome of open Anderson-Hynes pyeloplasty for pelviureteric junction [PUJ] obstruction in terms of renal function and complications. Descriptive study. Department of Urology at Peoples University of Medical and Health Sciences for Women Hospital Shaheed Benazir Abad [Nawabshah] from 2007 to 2009. Thirty consecutive cases of pelviureteric junction obstruction were admitted. All patients underwent Anderson-Hynes open pyeloplasty. Complications and outcome were recorded. Most of our patients were male [n=25]. Majority belonged to age group 1-5 year [n=18]. Left side was affected in most of the cases [n=22]. Low incidence of postoperative accepted complications noted. Post operative outcome was excellent In relation to improved drainage and renal function. Anderson-Hynes pyeloplasty was safe, with low postoperative complication rate and better renal function preservation

comparative study of trans urethral resection versus trans urethral incision for small size obstructing prostate

To compare the results of transurethral resection of prostate [TURP] with transurethral incision of prostate [TUIP] for small size obstructing prostate. Comparative study. Department of Urology, Peoples University of Medical and Health Sciences for women Hospital Nawabshah, from 2008 to 2010. Patients were divided in TURP and TUIP groups with fifty patients in each. Patients of any age with small size [thirty grams or less] prostate needing surgical intervention were included. TURP was done with conventional technique. In TUIP two deep incisions were made at 5 and 7'O clock positions of the bladder neck using Collings knife. Pre-per and postoperative variables were observed and recorded. All patients were followed up to six months post operatively. A total of 100 patients were included in the study. Mean operative time was 12.4 minutes in TUIP and 22.6 minutes in TURP. Retrograde ejaculation and blood transfusions were less in TUIP than TURP. The improvement in maximum flow rate improved in both the groups. TUIP is as effective as TURP in achieving maximum flow rate but TUIP was superior in terms of shorter operative time, less retrograde ejaculation and less need of blood transfusion

comparative study of percutaneous suprapubic cystolitholapaxy versus open cystolithotomy in children

To compare the outcome of percutaneous suprapubic cystolitholapaxy with open cystolithotomy in children. Comparative study. Department of Urology and Surgery, Peoples Medical College Hospital Nawabshah, from 2004 to 2007. Hundred patients [87 boys and 13 girls], from 1 to 10 years of age were enrolled in the study. The size of stones ranged from 8mm to 25mm. Patients were divided in two equal groups A and B. Group A submitted for percutaneous suprapubic cystolitholapaxy and group B for open cystolithotomy. The procedure was done under spinal and caudal anesthesia with intravenous sedation. To compare the outcome of percutaneous suprapubic cystolitholapaxy with open cystolithotomy Postoperative complications noted in group A patients included transient hematuria in 2 cases [p 0.495]. Operative time in group A was 10 to 15 minutes while in group B it was 25 to 40 minutes [p 0.0005]. Urinary leakage [n=2 - p 0.495] and wound infection [n=3 - p 0.242] were observed in group B. Duration of catheter placement was 2-3 days in group A, while 5 to 7 days in group B [p 0.0005]. Hospital stay of group A was 2-3 days while 5-7 days in group B [p 0.0005]. All patients became stone free. Percutaneous suprapubic cystolitholapaxy is an efficient, safe, minimally invasive and cost effective method