Frequency of malignancy in solitary nodule and multinodular goiter

To determine the frequency of malignancy in solitary nodule as well as multinodular goiter. Prospective observational study. Two years study from November 2006 to October 2008 was conducted in Liaquat University Hospital, Jamshoro and People's Medical College Hospital, Nawabshah. The study comprises 50 patients. All were admitted from OPD of both hospitals. The patients were evaluated fully after history and examinations and specific investigations of thyroid profile, scan, FNAC, indirect laryngoscopey and general assessment. All patients with solitary nodule and multinodular goiter included. Out of 50 patients 49 underwent surgery and tissue sent for histopathology. In this study of 50 patients of nodular goiter, 42 [84%] were female and 8 [16%] were male. The maximum number of patients were in age group 16-70 years. In 27 patients of multinodular 24 were female and 3 male. In 23 patients of solitary nodule 18 were female and 5 male. Regarding the histopathological results 10 [20%] patients showed malignancy, 8 [16%] in solitary nodules and 2 [4%] in multinodular goiter. Papillary.carcinoma seen in 7 [14%], follicular carcinoma in 2 [4%] and 1 [2%] as anaplastic carcinoma. Thyroid malignancy more common in solitary nodule as compared to multinodular goiter

Carcinoma rectum: presentation and outcome of different treatment modalities

To find out different presentations of carcinoma rectum and efficacy of different methods of its treatment. Three years observational prospective case study of 42 cases of Carcinoma of Rectum was conducted in Liaquat University Hospital, Jamshoro and people's Medical College Hospital, Nawabshah from June 2005 to May 2008. All the patients were assessed comprehensively and underwent for surgical intervention accordingly. The age ranged between 20-90 years of the 42 patients with mean age 52 years and male to female ratio was 2:1. 40.4% cases presented with bleeding per rectum and 21.4% with altered bowel habits. More than 50% tumour was located in lower third of rectum. Regarding Duke's classification, 40 [95.23%] were in C and D stages. Out of 42 cases, 21 [50%] were underwent with colostomy, 5 [11.9%] by anterior resection, 7 [16.6%] by abdomino-perineal resection and [11.9%] by Hartman's procedure. Wound infection seen in 28.8%, urinary tract infection in 19.2% and colostomy complications in 20.6%. All the patients with bleeding per rectum should be referred to the hospitals for early evaluation and proper management. Late referral and diagnosis make life miserable with permanent stoma in our social setup

experience of day care surgery in general surgical unit at people's medical college hospital, Nawabshah

To determine the feasibility of surgical procedures performed as 'day care cases' and their complications. An observational prospective study was conducted in the Department of surgery unit-Il, People' Medical College Hospital, Nawabshah from January 2002 to December 2007. A total of 1440 patients had undergone day care surgery During a period of 05 years. Surgery was carried out under local anaesthesia, local anaesthesia and sedation, regional Anaesthesia and general anaesthesia in children. Excision of skin and subcutaneous lesions were the commonest procedures performed [40%]. Complications Were observed of less significant. The hospitalization rate was [4%], which was unplanned. Significant number of elective procedures, minor and medium, can be performed as 'day care cases'. This does reduce the hospital admission burden

Frequency of hypocalcaemia in thyroid surgery

To determine the frequency of hypocalcaemia in thyroid surgery. This prospective study has been conducted at Surgical-IV in Liaquat University Hospital, Jamshoro/Hyderabad and Surgical Unit-II in Peoples Medical College, Nawabshah over a period of Two years from February 2006 to January 2008. This is a hospital based case series of 100 patients, who underwent subtotal, near total and total thyroidectomy for benign and malignant thyroid lesions. The age of the patients ranged between 15-70 years with mean age 32 years. 85 patients are female and 15 are male. In 18 patients, out of 100, hypocalcaemia has been observed clinically as well biochemically. It is concluded that frequency of hypocalcaemia is significant but only a few of them present with symptoms and permanent hypoparathyroidism is very rare

Varicocelectomy high ligation versus low ligation

To find out the outcome of two modalities in management of varicocele comparing high ligation [Paloma's procedure] and low ligation [Ivanissivich's procedure] This observational descriptive study was carried out in Surgical units of People's Medical College Hospital Nawabshah on 60 patients, belonging to age group of 15 to 36 years from January 2002 to December 2006. Patients with varicocele were divided in two groups of treatment modality equally. Group I comprising 30 patients for high ligation whereas 30 patients were kept in Group II for low ligation. Follow up was carried out for two years but response was poor. Varicocele had been observed on left side in most of the cases [95%]. Three cases [5%] presented in Grade-I, 21 [35%] in Grade-II and 36 [60%] in Grade-III varicoceles. Oligospermia was detected in 15% of cases. Group I patients were apprehensive regarding disappearance of dilatation and hanging veins postoperatively seen in 70% of cases whereas disappearance of veins were seen in 93.34% in Group II patients. Complications like haematoma and hydrocele are seen in Group II patients as compared to Group I. Wound infection and recurrence remained almost the same in both groups. High ligation was better tolerated with less complication but did require more counseling regarding disappearance of dilated veins. Paloma's procedure also does not disturb the normal anatomy of inguinal canal

Primary closure of perforated peptic duodenal ulcer

To find out the morbidity and mortality of primary Closure of perforated peptic duodenal ulcer with an omental patch. An observational descriptive study, from February 2003 to January 2006. This study is Carried out in Surgical units of People's Medical College Hospital Nawabshah on 92 patients of perforated duodenal ulcer were included in this study with male to female ratio 8:1. The age varies between 26-45 year with peak age incidence 35 years. The perforation closed primarily with vicry1-0 and supported with omental patch. Peritoneal lavage performed and drain kept in all cases. All patients were investigated for H. pylori and treated with eradication therapy in infected cases. Follow up carried out with upper G.I. Endoscopy at 6 weeks, and then six monthly for two years. Out of 92 cases, only 5 cases had recurrence within two years and wound infection remained the major post operative complication seen in 20% and chest infection in 15% of cases. No mortality seen in this study. Omental patch repair as primary closure of perforated peptic duodenal ulcer is effective surgical treatment with excellent results. The eradication therapy for H. pylori is adequate and comparable with definitive surgical treatment for peptic ulcer

Primary closure of perforated peptic duodenal ulcer

To find out the morbidity and mortality of primary closure of perforated peptic duodenal ulcer with an omental patch. An observational descriptive study, from February 2003 to January 2006. This study is carried out in Surgical units of People's Medical College Hospital Nawabshah on 92 patients of perforated duodenal ulcer were included in this study with male to female ratio 8:1. The age varies between 26-45 year with peak age incidence 35 years. The perforation closed primarily with vicryl-0 and supported with omental patch. Peritoneal lavage performed and drain kept in all cases. All patients were investigated for H. pylon and treated with eradication therapy in infected cases. Follow up carried out with upper G.I. Endoscopy at 6 weeks, and then six monthly for two years. Out of 92 cases, only 5 cases had recurrence within two years and wound infection remained the major post operative complication seen in 20% and chest infection in 15% of cases. No mortality seen in this study. Omental patch repair as primary closure of perforated peptic duodenal ulcer is effective surgical treatment with excellent results. The eradication therapy for H. pylon is adequate and comparable with definitive surgical treatment for peptic ulcer

Usefullness of topical glyceryl trinitrate in chronic anal fissure

To assess the effectiveness of topical Glyceryl Trinitrate in the treatment of Chronic Anal Fissure. Prospective Observational study from April 2004 to March 2005. Surgical Unit II, Peoples Medical College Hospital, Nawabshah. A total of 46 patients with Chronic Fissure-in-Ano. The data of all the patients who were recruited for the use of 0.2% topical Glyceryl Trinitrate was collected and analyzed for gender, age, symptoms' duration, site, and associated diseases. These patients were followed at regular intervals of four, six, eight and 12 weeks, and six and 12 months to assess the outcome, adverse effects and recurrence. Out of the 46 patients, six did not came back for follow-up, hence they were excluded. Amongst the remaining 40 cases, there were 14 males and 26 females, with ages between 16-64 years. In 26 [65%] patients, the fissure healed completely during eight weeks duration, whereas 10 [25%] patients experienced headache. Recurrence occurred in six [15%] patients; in them lateral internal sphincterotomy was performed. Topical Glyceryl Trinitrate is a good treatment option, as the success rate was 65%, with only 15% recurrence. It is well tolerated and has no chances of faecal and flatus incontinence