Causes and management out come of peritonitis

This retrospective study was conducted to study the different causes of peritonitis and to determine the surgical outcome. Retrospective study. This study was carried out at the Department of Surgery Peoples Medical College Hospital Nawabshah from 1[st] January 2001 to 31[st] December 2001. In this study of 51 patients of peritonitis admitted, out of them, 16 cases of typhoid ileal perforation, 8 cases of perforated duodenal Ulcer, 7 cases of tuberculosis of those 2 cases were of jujenal perforation and 5 cases of ileal perforation, 4 cases of perforated appendix, 4 cases of ruptured liver abscess, 2 cases of perforated neoplasms of those 1 case each with multiple ileal/ jujenal perforation due to lymphoma ,malignant caecal perforation, gastric perforation, jujenal perforation obstructive/strangulated, infective caecal perforation each, 2 cases of post operative peritonitis, 3 cases trauma, 2 cases of blunt abdominal trauma each developed peritonitis due to ileal and jejunal perforation, 1 case of gunshot injury causing peritonitis due to colon perforation, 2 cases of ruptured ovarian cyst associated with appendicitis. In our study, male to female ratio is 4:1. Maximum frequency was observed in 20-30 years age, whereas most of the patients ranged between 13 to 40 years. Surgical outcome of the peritonitis resulted poor in those cases who came late with hugely contaminated peritoneal cavity when operated. They developed post operative complications i.e. wound infection, septicemia, fecal fistula and longer hospital stays. 22 patient's outcome was poor and out of them 8 patients expired. The mean hospital stay was 23.0 +/- 17.7 days and the range was 67[3-110 days]

Ureteroscopic lithotripsy: a day-surgery procedure

Objective: To ascertain patient's safety and efficacy of ureterolithotripsy as a day-surgery procedure

Study Design: An interventional study

Place And Duration: At Citi Medical Center Larkana, Ghulam Mohammed Mahar Medical College and Hospital Sukkur Peoples University of Medical and Health Sciences for Women Nawabshah between Dec: 2007 to Dec: 2012

Methodology: All the patients of either sex having ureteral stone less than 1.5 cm in diameter were selected on the basis of routine clinical examination, laboratory investigation like complete blood count and biochemistry, Ultra-sound and x-rays like intravenous urography [IVU] etc for ureteral lithotripsy. The Semi-rigid UreteroscopicG.O Fr with Swiss Lithoclast lithotripter was used

Results: Our study comprises 320 selected patients. Male to female ratio was 1.6:1. Average age of patients was 30.5 year. The mean stone diameter was 1.2 cm. The stones were successfully disintegrated and completely pulverized in 95% [n=304] cases. In remaining 5%[n=16] cases, the procedure was deferred. Among them, ureteric catheter or J J stent in 3% [n=9] and 2%[n=7] cases respectively had been left. Of them, former cases were due to failure of access to stone and ureteroscope did not negotiate at all and in later cases stone was presented in upper ureter and inadvertently floated up into the kidney [P< 0.05]. The operative complications like simple mucosal injury occurred in 11%[n=35] and minor bleeding which did not cloud the field of vision occurred only in 13%[n=42] cases. The Mean operating time was 27[ranged from 22 to 55] minutes. Postoperative complications like urinary tract infection [sepsis] with fever and persisting haematuria had occurs in 5.5%[n=18] cases 9%[n=29] respectfully. The hospital stay was merely a day in all except 15% [n=47] cases who developed post-operative complications [P< 0.05]. In 03 week follow-up, residual fragments were noted only in 6%[n=19] cases. These patients were managed conservatively except 2%[n=7] cases that underwent repeat ureteral catheterization for manipulation of fragments which were jammed together, remit

Conclusion: Although, our study has documented high success rate and low morbidity with merely a day hospital stay but is dependent on many potentially modifiable and process-related factors

Extracorporeal shock wave lithotripsy [ESWL] vs. ureterorenoscopic [URS] manipulation in proximal ureteric stone

To compare the stone free rate at one week after extracorporeal shoch wave lithotripsy [ESWL] and ureterorenoscopic [URS] manipulation for proximal ureteric stone [10 - 15 mm size]. Randomized controlled trial. Sindh Institute of Urology and Transplantation [SIUT], Karachi, from August 2010 to February 2011. One hundred and ninety patients with 10 - 15 mm proximal urteric stone, in each group were treated with ESWL and ureterorenoscopic manipulation by using and 8.0 or 8.5 Fr semi rigid ureteroscope. Intracorporeal lithotripsy was performed by using pneumatic lithoclast. The stone free rate were compared between groups by considering size of stone at one week after procedure. The success rate, re-treatment rate, auxiliary procedure and complication rate were compared in each group. Success rate was 49.2% for ESWL and 57.8% for URS [p = 0.008]. The re-treatment rate was significantly higher in ESWL group than in URS group [40% vs. 11 and 18% in URS group]. Although ESWL is regarded as the preferred choice of treatment for proximal ureteric stone, the present results suggest that ureterosrenoscopic manipulation with intracorporeal lithotripsy is a safe alternative, with an advantage of obtaining an earlier or immediate stone-free status. Laparoscopic approaches are reasonable alternatives in cases, where ESWL and URS have failed

Suprapubic cystolitholapaxy: a variable option for paediatric bladder stones

To assess the complications of suprapubic cystolitholapaxy as an alternative procedure for bladder stones in pediatric age group. Prospective analystical study. This study was carried out in Department of Urology, University of Medical and health sciences Jamshoro from May 2006 to December 2010. this study consisted of 148 patients admitted though the outpatient department of Liaquat University Hospital Jamshoro/Hyderabad. All patients underwent base line and specific investigations especially ultrasound of abdomen and pelvis as diagnostic modality for assessment of bladder stones. Inclusion criteria were all these patients who after counseling for this study and gave written consent parents. Irrespective of their sex and age < 12 years of age presented with bladder stone of < 3cm. Exclusion criteria included were patients having history of previous surgery, posterior urethral valves, stricture urethra and stone > 3 cm were excluded from the study. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 148 patients, 124 [83.78%] were boys and 24 [16.21%] were girls with ratio 5.1:1 respectively. Mean age of the patients was 5.3 years with range from 1 to 11 years. Twelve [8.1%] patients presented with retention of urine due to impacted stone at bladder neck or prostatic urethra while 16 [10.81%] patients had coexisting renal stones. The mean size of the stones was 1.9 cm with range from 1.1 to 2.8 cm. Total operative time ranged from 25 to 40 minutes. Patients were discharged after observing first void on 2[nd] post-operative day 136 [91.89%] while twelve [8.11%] patients required further stay due to either suprapubic urinary leakage in 5[3.37%] or urinary retention in 7[4.72%] patients. Percutaneous suprapubic cystolitholapaxy is safe and cost-effective alternative to open surgery in children with

Consanguinity, family history, and risk of epilepsy: a case control study

To assess the association between consanguinity and family history in the risk of developing epilepsy later on in life. A case control study was carried out using data from 234 records comprising cases and controls in the proportion of 1:2. The cases were 76 patients suffering from idiopathic epilepsy, and the controls were 151 diseases patients who were non-epileptics. Data were analyzed using PASW Version 18.0. Chi square test was used to test associations and a binary logistic regression was done to calculate the adjusted odds ratio. The study population comprised 53.7% males and 46.3% females. 48.3% of the cases were of South Asian origin. The most common age group among the cases and the controls was 11-40 years. Both family history and consanguinity had an association with epilepsy. 81% of cases had a positive family history when compared to the 19% in the controls. The odds ratio was 18.37 [CI= 8.37-40.3]. 17% of cases had a positive history of consanguinity compared to the 31% in the controls. The odds ratio was 0.46 [CI= 0.22-0.90]. An adjusted odds ratio was done and the net effect was calculated. It was seen that the adjusted odds ratio for family history was 17.7 [CI=8.04-39] and the adjusted odds ratio for consanguinity was 0.53 [CI=0.23-1.19]. Therefore, family history has a significant association with epilepsy. There was a significant association between family history and risk of developing epilepsy and there seems to be no link between epilepsy and consanguinity. However, most of our patients did have a positive family history