Microbiology of bile in symptomatic uncomplicated gallstone disease

To determine the microbiology of the bile culture and antimicrobial susceptibility in patients with symptomatic gallstone disease in our setup. A descriptive study. Surgical Department Combined Military Hospital [CMH] Kharian from Oct, 2010 to Jun, 2011. A total of 106 patients underwent cholecystectomy due to symptomatic gallstones and their bile was cultured for aerobic and anaerobic bacteria and culture sensitivity was performed. Data was analysed by using statistical package for social sciences [SPSS] version 13. Bile culture was negative in 81 patients [76.4%] and was positive in only 25 patients [23.6%]. Escheria Coli was the most common cultured organism in 10 [40%] patients, Klebsiella in 5 [20%] patients, Pseudomonas in 5 [20%] patients, Proteus in 2 [8%] patients, Staphlococcus aureus in 2 [8%] patients and mixed organisms were cultured in 1 patient [4%]. Cefoperazone with sulbactum and Amikacin were the most effective prophylactic antibiotics. Bile in majority of patients with symtomatic uncomplicated gallstone disease is sterile. E. coli is the most commonly cultured organism and cefoperazone with sulbactum and amikacin are the most appropriate antibiotics in our setup

Short-term outcome after polypropylene darn and lichtenstein's hernioplasty: a randomized prospective study

To evaluate and compare the short term outcome of polypropylene darning with Lichtenstein's Hernioplasty for primary inguinal hernia. Randomized control trail. The study was conducted in CMH Sialkot, CMH Jhelum and PAF Hospital Mianwali from October 2000 to March 2005. A study of 270 patients with primary inguinal hernias was conducted in different hospitals. Group I [n=132] underwent darning with polypropylene while Group II [n=140] was subjected to Liechtenstein's operation. It was a simple randomization using random number tables. Patients above 18 and below 75 years age were included in the study and those with gross obesity basal metabolic rate [BMR] >35; chronic obstructive pulmonary diseases [COPD] and other chronic ailments were excluded from study. The patients were randomized and placed in either of the groups. Both the procedures were evaluated post-operatively for pain, inflammatory response [by measuring C-reactive protein [CRP] levels in blood], operation time, cost of procedure and various complications. All patients were discharged after 48 hours and were called again after 7 days for removal of stitches and then after 14 days for any post op evaluation. Patients were then examined after 3 months and then yearly for 3 years. Any complication in the intervening period, or thereafter, was also reported by the patient. There is insignificant difference in short-term outcome of both the procedure in terms of recurrence rate and other complications. The recurrence rate was 2.27% in group I while it was 2.14% in group II. Other complications like hematoma/ seroma formation, infection, ischemic orchitis, hydrocele, ingynodynia and post-operative pain did not show significant difference in both the groups. Total cost of biomaterial in Lichtenstein's operation exceeds Rs 1800 as compare to Rs 200 for darning. Darning with polypropylene is still cost effective and comparable with Lichtenstein's operation when dealing with a large majority of patients with primary inguinal hernia in our setup. Improving the technique and better patient selection can further decrease the recurrence rate

Acute abdomen; causes

The term [acute abdomen] denotes any sudden spontaneous non-traumatic disorder whose chief manifestation is in the abdominal area. There is frequently a progressive underlying intra-abdominal disorder, the correct early diagnosis and treatment of which is essential for a favorable outcome. [I] To find out the most common causes of acute abdomen. [II] To compare the preoperative assessment with postoperative diagnosis. A Non-interventional Analytical [Comparative] study. Emergency department of Combined Military Hospital Kharian. Oct 2001 to Mar 2002. Total of 220 patients who presented with acute abdomen. The most frequent cause was found to be Acute Appendicitis, followed by Nonspecific abdominal pain, acute cholecystitis, acute intestinal obstruction and perforated duodenal ulcer. Preoperative diagnosis was wrong in 9.5% [n=21] of cases. Acute appendicitis was found to be the most common cause of acute abdomen and the single most important cause of acute abdominal pain causing great diagnostic difficulties, the preoperative diagnostic accuracy can be increased especially in female of child bearing age by using modern diagnostic tools especially laparoscopy