One stage emergency resection and primary anastomosis of sigmoid volvulus

To evaluate the safety of single stage resection and primary anastomosis [RPA] in cases of viable sigmoid volvulus, in terms of anastomotic healing and complications. Observational study. Surgical Unit, Hayatabad Medical Complex [HMC], Postgraduate Medical Institute, Peshawar, from November 2006 to October 2008. Study included all patients presented and admitted in Surgical Unit, HMC, with sigmoid volvulus during the above mentioned period. Resection and primary anastomosis was done without defunctioning stoma formation or on-table colonic lavage. Manual decompression was carried out pre-operatively. Patients excluded, had serious co-morbid conditions in whom colostomy was done instead of primary anastomosis. Patients were followed-up for one month after surgery. A total of 30 patients were admitted during the study of 2 years duration, out of which there were 21 male and 09 female patients, with male to female ration of 2.4:1. Only 1 patient and anastomotic leak while 4 patients had superficial wound infection. One patient died due to comorbid condition. Abdominal wound dehiscence or postoperative abdominal abscess was not observed in any case. Single stage resection and primary anastomosis is a reliable current treatment modality for the emergency surgical management of sigmoid volvulus and has low morbidity and mortality. On-table colonic lavage and proximal defunctioning colostomies are unnecessary with this technique

Causes of mechanical intestinal obstruction in adults

To investigate the causes of mechanical intestinal obstruction in adults at surgical C unit Lady Reading Hospital Peshawar. This case series study was conducted at surgical C unit, of Lady Reading Hospital Peshawar, Pakistan from July 2006 to June 2007. In this study a total of 93 patients were included; who underwent exploratory laprotomy. These patients were diagnosed on the basis of clinical history, examination and radiological findings. After resuscitation, exploratory laprotomy was performed to confirm the diagnosis and relieve the obstruction. Laprotomy findings were recorded and where necessary specimen was sent for histopathology for definitive diagnosis. In this study of 93 cases, 100% patients presented with pain and abdominal distension. Other symptoms were less frequent. Males were 50 [53.76%] and females 43 [46.24%] with a male to female ratio of 2:1. 72. Tuberculosis [36.55%] was the leading cause of mechanical intestinal obstruction followed by carcinoma of the large gut [22.58%] and postoperative adhesions [21.51%]. Five [5.37%] patients had obstructed herniae and four [4.31%] had malignancy of the small gut. Three [3.22%] patients were with Meckle's diverticulum while 2 [2.15%] each had appendicular adhesions, intussusception and sigmoid volvulus. The causes of intestinal obstruction are variable in different parts of the world. Tuberculosis was the leading cause of dynamic intestinal obstruction in this study

Intermittent urethral self dilatation for prevention of recurrent stricture

To find out the role of clean intermitting self dilatation [CISD] for the prevention of recurrent urethral stricture. This comparative study of patients undergoing optical urethrotomy for anterior urethral stricture was conducted in Surgical Unit Hayatabad Medical Complex, Khyber Medical Centre and Khyber Teaching Hospital Peshawar from July 2004 to June 2008. A total of 146 male patients were included in the study. They were divided into two groups of 73 each on alternate basis. Group A was control group and group B with clean intermitting self dilatation and were followed upto 8 months. Study results showed a high rate of recurrence in control group A i.e. 42 patients [57.53%] in comparison to self dilatation group B i.e. 26 patients [35.61%]. Clean intermitting self dilatation is an effective procedure in the prevention of recurrent urethral strictures for primary strictures and deep strictures between 0.5-1.5cm length after optical urethrotomy

Fine needle aspiration cytology [FNAC] and neck swellings in the surgical outpatient

Fine Needle Aspiration Cytology [FNAC] is a simple, quick and inexpensive method that is used to sample superficial masses like those found in the neck and is usually performed in the outpatient clinic. It causes minimal trauma to the patient and carries virtually no risk of complications. Masses located within the region of the head and neck, including salivary gland and thyroid gland lesions can be readily diagnosed using this technique. The objective of this descriptive study was to see the frequency of various pathological conditions detected on FNAC in patients presenting with neck swellings coming to Surgical Outpatient Department of Postgraduate Medical Institute, Lady Reading Hospital Peshawar. This study included patients with neck swellings presenting to the Surgical Outpatient Department of Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January 2007 to December 2007. Patients below 18 years of age were excluded. Patients' data were recorded. Samples of FNAC were sent to the cytologist and results recorded. Frequency of various pathologies was determined. The study included 50 patients with neck swellings. There were 16 male and 34 female patients with an age range of 15-55 years. Tuberculous lymphadenitis was the commonest diagnosis [36%] followed by reactive/non-specific lymphadenitis [18%]. Other pathologies were malignant neoplasms [14%], cysts [10%], benign neoplasms [8%] and sialadenitis [6%]. FNAC was inconclusive in 8% of cases. Carcinomas metastatic to lymph nodes were the most common type of malignancy followed by lymphoma and thyroid gland carcinoma [Papillary Carcinoma]. It is concluded that tuberculous lymphadenitis is still the commonest condition in patients presenting with neck swellings followed by non-specific lymphadenitis and malignant neoplasms especially metastatic carcinoma. FNAC is an easy and suitable tool for the assessment of patients with neck swellings in the outpatient clinics. Although its diagnostic accuracy is limited as compared to tissue biopsy but it is a good test for both screening and follow-up

Conservative treatment of appendicular mass without interval appendicectomy: is it justified?

To evaluate the justification for conservative treatment of appendicular mass without interval appendicectomy. This study was conducted at the department of surgery Postgraduate Medical Institute HMC Peshawar. It was a descriptive study including all those patients who presented with appendicular mass from January 2000 to December 2005. These patients were treated conservatively. Patients who responded to conservative treatment were sent home and were followed for months for any recurrent attack. Patients who did not respond to conservative treatment, were explored after further investigation. Patients who had recurrent attack in the follow up were offered appendicectomy. No patient was offered interval appendicectomy. Total number of the patients included in the study was 125. Patients responded to conservative treatment were 88% [n=110]. Failure of conservative treatment occurred in 12% [n=15]. Out of these abscess formation occurred in 8% [n=10] who responded well to open drainage with out appendicectomy while 4% [n=5] were explored after CT abdomen. Appendicitis was found in 2 cases [1.6%], ileoceacal tuberculosis, colonic tumour and appendicular tumour in 1 case each [0.8%]. All patients except for the 5 cases already explored were followed up for 18 months. Recurrent attack of acute appendicitis occurred only in 8.33% [n=10/120] and appendicectomy was performed on these patients. Conservative management is effective in the majority of the patients. Randomized control trial is needed to study the real need of interval appendicectomy