Upper GI endoscopy a review of 100 cases at independent medical college / independent university hospital, Faisalabad

Objective: To document various endoscopic findings in patients undergoing upper GI endoscopy in our endoscopy unit. Design: Observational

Patients and methods: The data of 100 patients who underwent upper GI endoscopy in Endoscopy Unit of Independent Medical College/ Independent University Hospital from April 2010 to December 2012 was analyzed. Demographic features, reasons for referral and endoscopic diagnoses were noted

Results: Among 100 patients, 35% were referred due to persistent vomiting, 28% due to epigastric pain / discomfort, 18 % due to dyspepsia and 7% due to retrosternal burning and upper gastrointestinal bleeding. Common endoscopic diagnoses were gastritis [28%], duodenitis [14%], gastroesophageal reflux disease / esophagitis [6%], esophageal varices [5%] and esophageal growth [4%]

Conclusions: The most common presenting complaint was persistent vomiting followed by epigastric pain / discomfort and the most common endoscopic finding was gastritis

Laparoscopy; its role in diagnosis of various gynecological conditions

Diagnostic Laparoscopy is considered to be the gold standard for the evaluation of the pelvis and is considered a safe procedure. Diagnostic Laparoscopy is a technique in the routine investigation and treatment of infertility as well as other gynecological problems. To determine, Laparoscopic findings in different gynecological conditions, different causes of infertility and complications of laparoscopy Retrospective, descriptive study. We reviewed case records of all patients who underwent laparoscopy for their different Gynecological problems. Data were collected from patient case records in a data entry sheet In our study a total of Thirty patients under went laparoscopy for investigation of different gynecological problems. There were 17 patients who have primary infertility and 6 have secondary infertility while 7 presented with Lower abdominal pain. In our study the leading cause of primary infertility was Polycystic Ovarian Disease[29%].Other causes were bilateral tubal blockade [23.53%] ,17% has PID and fibroid uteri, While one patients shown Endometriosis as well as one patient had no obvious pathology.[5.88%].On laparoscopic examination of secondary infertility 50% shown Tubal blocked while 16.67 shown Fibroid uterus and PID.One patient had normal pelvic findings[16.67]. Regarding patients presented with pain lower abdomen 57.15% has ovarian cyst, 28.58% has Ectopic pregnancy while one case[14.29%] had hetrotropic pregnancy. In 24 patients had no complication and recovery was smooth. laparoscopy had to be converted into Laparotomy due to significant hemorrhage in two patient and wound infection was observed in two patients. One patient presented with post operative fever and one presented with abdominal pain. Laparoscopy is a valuable diagnostic tool for females in different gynecological problems. The benefit of the laparoscopy to open surgery include less pain, less scarring, less disability and quicker recovery

Optimal timing for surgery in acute gall stone disease

Laparoscopic cholecystectomy is the gold standard treatment for patients presenting with acute gall stone disease necessitating hospital admission. To assess the impact of timing of laparoscopic cholecystectomy on conversion rate, hospital stay and morbidity. Jan 2008-2010. Department of Surgery, Independent University Hospital, Faisalabad. Experimental study. The subjects were included by consecutive sampling technique. 81 cases were divided into 3 groups. Group A [Surgery within 72 hrs of onset symptoms]. Group B [surgery between 72hrs to 96 hours of onset of symptoms]. Group C [surgery after 96 hours of onset of symptoms]. The mean age was 41-95 years. Female to male ratio was 4.5:1. The overall complication rate was 12.69%. Mean hospital stay was 2.85 days. The open conversion rate was 8.64%. In group A the complication rate was 6%, group B 11.5% and group C 12.8 and. The mean hospital stay and conversion rate had no significant difference. The timing of laparoscopic cholecystectomy has no significant impact on the conversion rate and length of hospital stay in cases with acute cholecystitis. However the complication rate was higher when surgery performed after 72 hours of onset of symptoms

Pneumoperitoneum; the effectiveness and intra peritoneal events while using veress needle

Introduction: Minimal access surgery has evolved enormously and revolutionised surgical practice. With increasing use of Minimal access surgery, safety of methods of creating Pneumoperitoneum have come under intense scrutiny

Objectives: To observe the effectiveness and intra peritoneal events of using veress needle to create pneumoperitoneum in minimal access surgery. Study design: Prospective observational study. Period: From April to June 2004. Setting: Department of Surgery at Norfolk and Norwich University Hospital

Subject and Methods: 50 patients with male to female ratio 25:1 Veress Needle 14G was inserted infra umbilically through stab incision at angle of 45 degree. BMI [body mass index] and abdominal thickness was recorded. Intra peritoneal events of flow of insufflated air, intraperitoneal position of needle and intraperitoneal adhesions were recorded

Results: [28/50] 56% of patients achieved free flow, [18/50] 36% patients achieved free flow with traction. 44% of patients had free veress needle tip and 44% had tip in omentum, 8% patients showed extra peritoneal air collection. All patients were fit enough to be discharged same day

Discussion: Our study has revealed that body mass index [BMI] and skin fold thickness does not effect the position of needle. With skin fold thickness increase free flow of air needs to be assisted by traction of abdominal wall

Conclusion: We conclude that Veress needle can be safely used for creating pneumoperitoneum in patients of any BMI and skin fold thickness