Frequency of urological carcinomas presenting as gross Haematuria in Punjab Pakistan and recommendation for its early diagnosis

Objective: To determine the frequency of various causes of gross Haematuria presenting in our hospital and recommend a working protocol to young doctors. Study Design: Prospective descriptive study. Place and Duration of Study: Urology Department, District Headquarter and Teaching Hospital, Sargodha Medical College, from Mar 2012 to Mar 2014

Material and Method: All fresh patients reporting to the hospital with complaints of 'blood in urine' were included in the study, while patients presenting with Microscopic haematuria were excluded. The patients, after being managed by the urology registrar, were given a questionnaire to fill, assisted by a resident, a reference number allotted for follow-up. A request for urine routine examination and urine microscopy/cytology was made to confirm haematuria and exclude malignant cells. Followed by ultrasound, X-Ray KUB, cystoscopy and IVU/CTU scan, as required. The results obtained were recorded and analyzed

Results: A total of 391 patients presented with complaints of 'blood in urine'. Trauma: was the most frequent cause seen in 21.7% [n=85], followed by Urinary tract infections [21.0%, n=82], Urolithasis [20.2%, n=79] and Urological tumors seen 19.4% [n=76] cases. About two thirds of the patients [56.6%, n=43] with urological tumors were not investigated, at primary health care level, to ascertain the cause and presented with advanced disease

Conclusion: General practitioners should be encouraged to request ultrasound scan for patients presenting with gross haematuria, as urothelial tumours, if detected early, can be managed effectively with better long term outcome

Malignant tumors; frequency at Sargodha, a single centre, retrospective study

As in most developing countries, incidence of cancer is also increasing in Pakistan. It is important that information on the frequency and epidemiology of malignant tumors be updated, as it is the basis of future health planning for the population at risk. This retrospective study was carried out to find the prevalence of various cancers in the population of Sargodha district [central Punjab, Pakistan] and to compare the regional and international studies, so as to plan and develop the oncology setup of Sargodha Medical College on a rationalized basis of disease prevalence. Data from July 2010 to June 2013 was retrieved from the department of statistics of the hospital and variables of interest were collected and analyzed using SPSS 10.0. It was observed that the most frequent cancer in our patients was breast cancer [n=172] while carcinoma of lungs was the most frequent carcinoma in male population [n=24]. However our observations were a bit different from the international studies published on the subject, the probable reason being the availability of treatment facility and easier access in the nearby districts of Faisalabad and Lahore where many patients still go directly. More over the illiterate and poorer faction of the society does not come to the hospitals for management of the disease but rather go to the quakes and faith healers to relieve them of their sufferings. It is concluded that the department of clinical oncology should arrange cancer awareness programs for the general population to avoid delays in getting consultation, as at present they report to the hospital when the disease is quite advance and surgery is often not possible. Our study also revealed a somewhat different pattern of malignancies in our community raising a need for further studies to evaluate the reasons for this changed pattern in relation to various etiological factors

Clinical audit of hemodialysis patients at dialysis centre a tertiary care hospital

Background: The incidence of end stage renal disease [ESRD] is between 100-150 new cases per million per year, with a disease burden of 27000 new cases each year in Pakistan. The treatment of first choice for these patients is renal transplantation, which is available to only 5% of patients, rest have no other option except to resort to dialysis to sustain their life

Objective: The objective of the study was to critically review and analyze the data of patients on the basis of etiology, dialysis type and outcome during the last three years so as to improve the patient care

Patients and Methods: In this descriptive study, all the patients, who underwent dialysis during three years [2009-2011] was retrieved from the statistics department. Variables of interest were identified. Data was collected, entered and analyzed in SPSS version 15. The results were then compared with national and international studies on the subject

Results: In this study, a total of 457 patients under went dialysis at the centre and 14687 dialysis sessions were performed during the period under study. Male to female ratio was 1.6:1 and mean age was 44.15 years. Hypertension [70%] was the major cause of ESRD. Fifty three percent patients had an arterio-venous fistula and 23.63% were suffering from hepatitis [C] before the first dialysis. Average survival was 7.7 months and 46.17% deaths were recorded

Conclusion: The management of ESRD being very expensive, government alone with a less than 0.5 to 0.8 percent of the GDP allocation for health cannot extend this facility to all the sufferers. The society should follow healthy life style practices so as the preventable causes of ESRD such as hypertension and DM can be controlled. Social groups should be formed in which these patients should actively participate, encourage and guide each other to improve their quality of life

Idmbotomy; an under utilized incision for renal and upper ureteral access

Urolithasis is a common urological ailment since antiquity. Treatment of urolithasis has witnessed a revolutionary change with the advent of minimally invasive endoscopic techniques. However in developing countries very few cases of the renal stone disease are being treated using minimally invasive techniques and vast majority are still being managed with open surgery. The objective of the study was to compare the two incisions used for renal and proximal ureter access, and find out which was better in our set up. We carried out a study at our center, comprising of 50 cases of solitary renal stones, to compare the traditional oblique lumbar [OL] incision with dorsal lumbotomy [DL]. Patients included in the study were with a BMI of less than 30, all ages, having single large stone of renal / proximal ureter, extra renal pelvis, no previous surgery on the ipsi-lateral side. The study revealed that the lumbotomy incision is better than the traditional lumbar oblique incision in terms of surgery time, post operative pain, early return to work and cosmetically accepted scar. After analyzing the data we came to the conclusion that the lumbotomy incision was superior to the oblique lumbar incision in selected cases and we recommend that it should be used specially in centers where facilities for endoscopic/minimally invasive management are not available

Management of gastric carcinoma; comparative analysis of various treatment modalities

To find the best treatment modality for carcinoma stomach. Case series study. Combined Military Hospital Rawalpindi. From January 1996 to December 1999. 42 cases of gastric carcinoma are included in this study. The mode of treatment predominantly remained surgical with the aim to cure the patient of this disease. The disease occurred mostly above the age of 50 years. Common clinical features were unexplained weight-loss, malnourishment and anaemia, respiratory tract infections. No specific etiological factor was detected except that, out of 42 patients 35 were smokers or had quit smoking during the past six years. Nearly all were having at least 8-10 cups of hot tea per day. Adenocarcinoma was the most frequently encountered histological type. 03 patients could not be operated upon because of extremely poor prognosis due to multi-organ failure. 12 patients were selected for surgery curative resection was carried out, whereas the remaining 27 were subjected to palliative resections. Five patients died during or within one month of surgical intervention. Out of the remaining 34, only 21 patients reported for follow up. In most of the patients in whom curative resection was performed, the quality of life was reasonably good. At the end of one year, another eight patients had died of tumour dissemination and cachexia, three patients developed tumour recurrence at the anastomotic site, and one patient developed stricture at anastomotic site. Patients with recurrence were sent for radiotherapy. It is concluded that for carcinoma of stomach the only possible treatment is surgery either alone or in combination with radiation and chemotherapy, the most common, preventable etiological factor is smoking, probably in combination with hot beverages in excess. The most common presentation remains weight loss with dyspepsia or weakness and anorexia, commonly effected age group is middle and old age, preoperative nutritional build-up achieves good postoperative results, palliative surgical procedures made the quality of life of the patient better. The prognosis remains extremely poor, in terms of morbidity and mortality

Necrotizing enterocolitis in premature babies; Laparotomy versus peritoneal drainage

Premature infants with necrotizing enterocolitis [NEC] or intestinal perforation [IP] are treated either surgically with laprotomy or peritoneal drain placement. [1] To develop a hypothesis about the relative effect of these 2 therapies on risk adjusted outcomes through 18 months in premature infants. [2] To obtain data that would be useful in designing and conducting a successful trial of this hypothesis. A prospective, observational study. In pediatric surgical departments of Military Hospital Rawalpindi and Combined Military Hospital Rawalpindi. From Nov 2005 to April 2007. To assist in risk adjustment, the attending pediatric surgeon recorded the preoperative diagnosis and intraoperative diagnosis and identified infants who were considered to be too ill for laprotomy. Severe NEC or IP in 156 of 2987 premature infants; 80 were treated with initial drainage and 76 were treated with initial laprotomy. By 16 months, 76 [50%] had died; outcome remained worse in subgroup with NEC. Laprotomy was not performed in 76% [28 of 36] of drain treated survivors. Drainage was commonly used, and outcome was poor. Our findings, particularly the risk adjusted odds ratio favoring laparotomy, indicate the need for a large, multicenter clinical trial to assess the effect of initial surgery therapy on out come at > 16 months