Résumé
Objective: to find out the prognostic significance of BISAP scoring system and its accuracy in predicting the severity of acute pancreatitis in comparison with Ranson criteria
Study design: cross-sectional study
Place and Duration of study: Department of General Surgery ward 26 Jinnah Postgraduate Medical Centre [JPMC] Karachi, from January 2013 to December 2014
Methodology: Patients of either gender more the 14 year of age with acute pancreatitis admitted through emergency department were included. All the patients were scored according to the Ranson criteria [at time of admission and at first 48 hours post admission] and BISAP score [in first 24 hours of admission]. Patients were categorized having mild or severe acute pancreatitis on the basis of organ failure for more than 48 hours and these patients were treated in HDU/ICU according to the standard protocol
Results: a total of 50 patients diagnosed as acute pancreatitis were admitted during the study period. The mean age of the patients was 43.48 +/- 15.75 year with the age range from 15 year to 75 year. There were 30 [60%] females and 20 [40%] males with F:M ratio of 1.5: 1. The duration of hospital stay was 2-50 days with mean of 12.15 +/- 5.85 days. Nine [18%] patients developed persistent organ failure for more than 48 hours and were classified as having severe acute pancreatitis. These patients underwent contrast CT- scan abdomen on day 3 of admission. Three of them had necrotizing pancreatitis. The frequency of severe form of acute pancreatitis stratified by the BISAP and Ranson score were both statistically significant [p < 0.001]. Three [6%] patients died during their hospital stay [mortality rate 6%]. All the three patients who died had Ranson score > 3 and BISAP score = 3 respectively
Conclusion: in predicting the frequency of severity and mortality in patients with acute pancreatitis the BISAP scoring system is equally effective as Ranson scoring system
Résumé
Objective: to find out the effectiveness of anchoring mesh using stainless steel skin staples versus polypropylene sutures in inguinal hernia surgery with Lichtenstein's technique in terms of operation time, postoperative pain and recurrence of disease
Study design: randomized controlled trial
Place and Duration of study: department of Surgery ward 26 surgery, Jinnah Postgraduate Medical Centre Karachi, from February 2014 to January 2016
Methodology: patients above 18 year of age who underwent inguinal hernia repair using mesh were included. They were randomly assigned in to Group A in which the mesh was secured using stainless skin staples and Group B where mesh was anchored using polypropylene [Prolene] 2/0 sutures. The operative time was recorded in both the groups. All the patients were followed up in outpatient department for recording the postoperative pain on the visual analogue scale [VAS]
Results: sixty-four patients fulfilling the inclusion criteria were included. They were randomly divided into two groups of 32 patients each. The mean age of Group A and B patients was 45.85 +/- 13.50 year and 48.56 +/- 14.56 year respectively. Total operation time and from mesh placement to skin closure was found significant in favor of group A [p <0.001]. At 7[th] postoperative day in Group A twelve patients had no pain, Fifteen had mild, four with moderate and one patient had severe pain. In Group B ten patients reported no pain, fourteen had mild, five moderate and three with severe pain. Three patients in group A and four in Group B developed seroma postoperatively. Wound infection developed in one patient in group B. There was neither mesh related infection nor recurrence of hernia in either of the groups
Conclusion: operation time was shorter in patients where staples were used. Postoperative pain was also less in intensity in this group
Résumé
Objective: To compare the diagnostic usefulness of RIPASA and Alvarado score in identifying patients with acute appendicitis presenting with right iliac fossa pain
Study design: Cross sectional analytical
Place and Duration of study: Department of Surgery Unit III, Jinnah Postgraduate Medical Centre [JPMC] Karachi, from December 2013 to December 2015
Methodology: All patients above 15 year age of either sex with right iliac fossa pain, were included in the study. All patients were clinically assessed and scored as per Alvarado and RIPASA scoring systems. Decision for appendectomy was based on the surgeon's clinical judgment. The scoring systems were used for the study purpose. The histopathological findings were compared with the scores of the two systems
Results: Using RIPASA scoring criterion, 172 [86%] patients were suspected to have acute appendicitis. Out of these 164 patients had acute appendicitis on histopathology report [true positive - TP] where as 8 were false positive [FP], 16 false negative [FN] and 12 true negative [TN] for acute appendicitis. Using Alvarado score, only 22 [11%] were suspected to have acute appendicitis. A total 21 patients were confirmed true positive [TP] based on histopathology, only one false positive [FP], 159 false negative [FN] and 19 true negative [TN]. The sensitivity of RIPASA score was 91.11%, specificity 60%, PPV 95.34%, NPV 42.85%, diagnostic accuracy 88% and rate of negative appendicectomy was 10.25%. Sensitivity of Alvarado score was 11.67%, specificity 95%, PPV 95.45%, NPV 10.67%, diagnostic accuracy 20% and negative appendicectomy rate was 0.132%
Conclusion: The RIPASA score was reliable and sensitive diagnostic tool to make diagnosis of acute appendicitis
Résumé
Intestinal perforation due to lymphoma is rarely reported. A 22 year old male patient presented to emergency room with acute abdominal pain. He was operated after resuscitation and at laprotomy a large conglomerated mass with multiple perforations of small bowel found. Histopathological examination of resected bowel segment revealed B-cell non- Hodgkin's lymphoma. During postoperative course patient developed enterocutaneous fistula. This patient was later referred to oncologist for chemotherapy. He was lost to follow-up while being treated