RESUMEN
Objective: to determine the efficacy of ultrasound shear in laparoscopic cholecystectomy in terms of total operative time, postoperative bile leaks, gall bladder perforation rate, and postoperative bleeding from cystic artery and collateral injury to bowel and duodenum
Study Design: comparative study
Place and Duration of Study: Mayo Hospital, Lahore, from June 2013 to May 2014
Methodology: 150 cases [75 in each group] were randomized into two groups, i.e. harmonic scalpel clipless group [HSG] versus conventional laparoscopic cholecystectomy [CLC] with electrocautery group. The above stated variables were documented. The data for age, blood loss, and drain output were positively skewed as calculated using the Shapiro-Wilk test. The histograms, Q-Q plots and box plots were analyzed for all the dependent variables. Skewed qualitative continuous data was analyzed using the Mann-Whitney U-Test
Results: operative time was significantly lower in HSG as compared to CLC. Median operative times were 30 minutes [IQR 10] versus 35 minutes [IQR 10] [p<0.001]. HSG group had perforation rate of 5/75 [6.67%] as compated to 16/75 [21.33%] in CLC [p=0.010]. Intraoperative blood loss in group A was significantly lower than in group B [p=0.001]. Postoperative median pain score was 3 [IQR 2] versus 3 [IQR 3] in HSG versus CLC, respectively
Conclusion: all the primary outcomes showed improved results in the ultrasound shear group as compared to the group for conventional electrocautery
RESUMEN
Objective: this article discusses etiopathogenesis, diagnostic problems and various management modalities available to manage skull base osteitis [SBO] which is a rare but life threatening disorder and in addition national and international references will be reviewed
Material and Methods: cross sectional, retrospective study carried out at ENT unit-SIMS/SHL which included 17 patients with SBO which were sorted out for etiological diagnosis based on detailed history, physical examination and labs
Results: mean age was 52 years. Diabetes is the most significant risk factor and was seen in 82% of patients, pseudomonas was isolated in 8 patients. The main complication facial paralysis was present in 64% of patients
Conclusion: SBO remains a severe debilitating and life-threatening condition. It may develop in patients with benign otitis media and externa, and must be considered in all patients with temporal bone inflammation; especially those with risk factors and those who fail to improve with more conservative measures. Small-vessel vasculopathy and immune dysfunction associated with diabetes are primarily responsible for this predisposition. Cranial nerves most commonly the facial, can be affected by inflammation along the skull base or by a neurotoxin produced by Pseudomonas species. We, in this article, intend to share our experience in managing seventeen patients with SBO over a period of three years and review the relevant and recent global literature suggesting updates
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Background: Acute appendicitis is common cause of abdominal pain in pregnancy. Present study aims to determine the presentation and diagnosis of acute appendicitis in pregnancy
Methods: It was descriptive study carried on 18 pregnant patients who underwent appendicectomy
Results: In this series 18 pregnant patients had appendicectomy, 17 had acute appendicitis, and 1 had normal appendix. Abdominal pain and vomiting were main presenting symptoms. Tenderness in right iliac fossa was main finding on clinical examination. 2 patients had perforated appendix for which lower midline laparotomy was performed. There was no fetal or maternal loss. Wound infection was major complication seen in 2 patients only
Conclusion: The diagnosis of acute appendicitis rests on clinical acumen, and prompt surgical intervention is the key to good outcome
RESUMEN
The usual clinical behavior of Juvenile nasopharyngeal Angiofibroma is one of locally expanding growth with a potential for intracranial extension. The management of the tumour has raised many important and interesting issues to both the surgeons and radiotherapists. The sophisticated diagnostic techniques, better an aesthetic and operative facilities have reduced the complications associated with this tumour. The surgical approaches for this tumour have evolved over a long period of time. This study includes management of Juvenile nasopharyngeal Angiofibroma in 25 patients where different treatment modalities were offered. Operative procedures giving widest possible exposure for that specific situation are the treatment of choice and radiotherapy is generally reserved for unrespectable lesions
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Tuberculosis of the middle ear and the mastoid is not a very common condition. Traditionally it has been diagnosed because of its peculiar clinical features such as painless otorrhoea, sensori-neural hearing loss and multiple perforations in the tympanic membrane. We report a case in which there were no clinical features of tuberculosis, otorrhoea was painful and hearing loss was of conductive variety. The final diagnosis depends on histopathology and we recommend pathological examination of all tissue removed during surgery
RESUMEN
Two combinations clindamycin and gentamycin-[Group A]' and 'Metronidazole, ampicillin and cloxacillin -[Group B]' were used as part of the treatment in 71 patients of acute and perforated appendicitis. The infection rate in group A was 10% and in Group B was 14%. The results being comparable, the cost of treatment for Group A per patient was considerably less. In patients with peritonitis due to perforated appendix, wound sepsis was high despite appropriate antibiotics