Blood transfusion support in mass disaster and trauma situations an experience at a tertiary care center

Objectives: To assess the blood transfusion support requirements in mass disaster and trauma situations

Study Design: Cross-sectional observational study

Place and Duration of Study: This study was conducted at Combined Military Hospital Quetta from, Jan 2013 to Dec 2015

Material and Methods: Nature of injuries, triage details, details of surgical procedures and duration of hospital stay were noted. Data was analyzed with respect to cross match to transfusion ratio and the number of units of each component transfused. Patients requiring massive transfusion and any associated complications were also studied

Results: A total of 2228 casualties were received during the study period, of these, males were 18 [75 percent] and 6 [25 percent] were females. Mean age was29.7 years. 1636 [73.4 percent] casualties had sustained major injuries. Mean hospital stay was 6.31 days. Only 199 [12.2 percent] patients required blood transfusion with a mean of 2.9 units of RCC, 8.7 bags of FFP and 4.6 bags of platelets. Fifteen [7.5 percent] patients received massive transfusion. Following massive transfusion, one case of metabolic acidosis and two cases of coagulopathy were reported

Conclusion: Mass disasters and trauma casualties pose a serious challenge to any healthcare facility in general and the blood transfusion services in particular. Only a well-organized blood transfusion center and blood transfusion emergency preparedness can result in better patient care and outcome. Not all patients need transfusion and a delicate balance between demand and supply has to be maintained

Accuracy of Ca-125 concentration as predictor of peritoneal dissemination of colo-rectal carcinoma

Objective: To determine the association of CA-125 levels with the peritoneal dissemination among the patients of colo-rectal carcinoma at a tertiary care surgical oncology unit of Pakistan

Study Design: Observational study

Place and Duration of Study: Department of Surgical Oncology, Combined Military Hospital Rawalpindi. Duration of ten months, from Jan 2018 to Oct 2018

Patients and Methods: A total of 83 cases of colorectal carcinoma were included in the study, which were diagnosed by consultant oncologist after relevant histological and radiological investigations. Peritoneal dissemination was confirmed during the surgery. CA-125 levels were assessed before the surgery and cut off of 35U/mL was used. Relationship of age, gender, raised CA-125, tumor metastasis and tumor differentiation was assessed with the presence of peritoneal dissemination among the patients suffering from colo-rectal cancer

Results: Fifty nine patients were males and 24 were females. Mean age of the patients was 51.17 [+/-3.395]. Out of 83 patients of colo-rectal cancer, 37.3 percent showed the presence of peritoneal dissemination while 62.7 percent had no peritoneal dissemination at the time of surgery. Forty one patients had raised levels of CA-125 while 42 had levels within the normal range. After applying the logistic regression we found that raised levels of CA-125 and metastatic illness had significant association with the presence of peritoneal dissemination among the patients of colo-rectal cancer

Conclusion: CA-125 concentration emerged as a strong predictor of peritoneal dissemination of colo-rectal cancer in our study analysis. Routine checking of levels of this marker among the patients of Colon cancer may help in early recognition of the advancement of disease and help the surgical oncologists to manage it in a more effective way

Post-operative analgesic requirement in non-closure and closure of peritoneum during open appendectomy

Objective: To compare the mean post-operative analgesic requirement in non-closure and closure of peritoneum during open appendectomy

Study Design: Randomized controlled trial

Place and Duration of Study: Department of General Surgery Combined Military Hospital Quetta, from 1[st] August 2014 to 30[th] April 2015

Material and Methods: A total of 60 patients were included in this study and were divided into two groups of 30 each. Patients in group A underwent open appendectomy with closure of peritoneum while patients in group B had non-closure of peritoneum during the same procedure. Post-operatively, pain severity was assessed on visual analogue scale [VAS] numeric pain distress scale. On presence of VAS numeric pain distress scale between 5 to 7, intramuscular [IM] diclofenac sodium was given and on score >7, intravascular [IV] tramadol was given. The final outcome was measured at day 0 and day 1

Results: Pain score and analgesic requirements were significantly less in non-closure group than closure group on day 0 and day 1, showing statistically significant difference between the two groups

Conclusion: Mean post-operative analgesic requirement is significantly less in non-closure group as compared to closure group during open appendectomy

Repair of retrohepatic inferior vena cava injury

A 10 years old child was brought to the Emergency Department of Combined Military Hospital [CMH], Lahore with a history of trivial injury due to fall from a bicycle. He was found to be having severe intraperitoneal hemorrhage. Immediate resuscitation in the emergency department could not revive his vital parameters. He was operated upon in emergency and found to be having grade V hepatic injury extending into retrohepatic inferior vena cava. Child was operated under general anesthesia and recovered well postoperatively without any residual complication