Alternate and incidental diagnoses on noncontrast-enhanced spiral computed tomography for acute flank pain

Our aim was to determine the incidence and spectrum of significant alternate or incidental diagnoses established or suggested on spiral computed tomography [CT] in a large series of patients with suspected renal colic. Records of all patients that had undergone spiral CT [5-mm to 7-mm slice thickness] for acute flank pain during a 5-year period were reviewed. The radiological diagnoses of urinary calculi and obstruction as well as clinical entities not suspected otherwise were analyzed. A total of 4000 CT's had been performed in the evaluation of acute flank pain. Urinary calculi had been identified in 3120 patients [78%]. There were 398 patients [9.9%] who had an alternate cause of flank pain or an incidentally detected condition on CT. Of these patients, 102 [25.6%] had more than one additional finding. A total of 153 clinical conditions had been identified mimicking flank pain secondary to calculus and obstruction. In 47 patients [1.2%], incidental solid masses had been detected. Spiral CT is a valuable technique in the evaluation of acute flank pain with uncertain clinical diagnosis. A wide spectrum of alternate and additional diagnoses including abdominal solid organ tumors and other significant abdominal conditions such as pancreatitis can be established or suggested on spiral CT performed for suspected acute urinary colic

Outcome of different treatment options for periampullary carcinoma

To study the outcome of different treatment options for periampullary carcinoma. This study included 30 patients with periampullary carcinoma. A standard protocol was prepared for every patient comprising thorough history and full physical examination and relevant investigations. All this was recorded in data collection form. Later on outcome of different treatment options for periampullary carcinoma was discussed. All the patients were between 45-70 years. Most patients were male and belong to low socioeconomic class. The diagnosis was based on history, clinical examination and relevant investigations. The treatment options were divided into two groups. Curative resection [pancreaticoduodenectomy] was done in 18 [60%] patients. 12 [40%] patients had unresectable disease. These patients were treated by palliative procedures. Endoscopic stenting was done in 8 [66.7%] cases and 4 [33.3%] underwent surgical bypass. The morbidity noted in curative resection was [wound infection 20%, anastomotic leakage 15%, respiratory infection 10%, cholangitis 7.5% and renal failure 6.7%]. Six months survival after curative procedure was 90%. Morbidity of endocsopic stenting being blockage 20% and cholangitis in 75% of cases. Six months survival after stenting was 78%. Morbidity noted in surgical bypass included 15%[wound infection], chest infections 15% and six months survival being 75%. It was concluded that periampullary carcinoma is common in male predominantly with low socioeconomic class. Most patients were having resectable disease with relatively high morbidity

Association of tubal ligation or abdominal surgery with other gynecological illness

To determine the association of tubal ligation or abdominal surgery with other gynecological problems. A retrospective study was done in hospital setting of Islamabad and Rawalpindi. Women who had undergone tubal ligation or abdominal surgery were interviewed regarding the data collected has revealed the ligated women were more on risk for gynecological morbidity as compared to abdominal surgery cases. Screening for risk for developing gynecological problems prior to ligation should be done to prevent the chances of developing long term gynecological morbidity along with provision of premenopausal counseling

Comparison of complications between Mayo`s repair and Mesh repair [pre-peritoneal approach] for para umbilical hernia

Objective: The purpose of the study is to compare the rate of complications in Mayo`s repair with mesh repair. [Preperitoneal approach]

Design: Comparative study

Place and Duration of Study: Nishtar Hospital Multan during the period of January 2001 to August 2003

Patients and Methods: Only patients with fully reducible hernias were included in the study. Unfit patients having serious cardiac and respiratory illness, patients with obstructive and strangulated paraumbilical hernia were excluded from study. Two groups comprising of 25 patients each were made on random basis and operated [Mayo`s repair in-group one and mesh repair in-group two] randomly by surgical team. A separate file was kept for each patient. A detailed history and full physical examination and various investigations of all patients were carried out. Later on, operative findings and complications were also noted

Results: The age of the patients ranges from 20 to 60 years [mean 40 years]. 80% were female while remaining 20% were male The commonest mode of presentation was swelling in the umbilical region [100%] and dragging pain in the umbilical region during heavy working [60%]. On physical examination positive cough impulse was present in [80%]. There was significant difference between postoperative complications in two groups. As seroma formation [8% vs 0%], wound infection [8% vs 0%], wound haematoma [12% vs 4%] was seen more in group I. However mesh infection was present in-group 2 only

Conclusion: It is concluded that recurrences after open tension free repair are rare, complications are few, and the operation is simple to perform. Optimally hernias should be repaired using mesh repair

Role of open surgery in the management of staghorn calculus

Objective: To evaluate the role of open surgery in the management of staghorn calculi by comparing it with other available modalities of treatment i.e. percutaneous nephrolithotomy [PCNL] and extracorporeal shockwave lithotripsy [ESWL] and assessing improvement in the renal function [parenchymal thickness and glomerular filteration rate [GFR] after stone removal

Design: Institutional- based prospective study

Place and Duration of study: This study was conducted at the department of Urology, Nishter hospital, Multan from January 2000 to February 2002 [2 years]

Subjects and Methods: A total of fifty patients with staghorn calculi who underwent open surgery in the department and completed a three-month follow-up were included in the study. All patients had a complete blood examination [CBE], complete urine examination [CUE] [including culture and sensitivity [CIS], renal parameters [urea and creatinine], renal tract ultrasonography [USG] preoperatively and at first, second and third month of follow-up to assess the improvement in heamoglobin, control of urinary tract infection [UTI], parenchymal thickness and postoperative complications. Tc99m DTPA scan was employed before surgery and at third month of follow-up to evaluate the improvement in GFR for operated kidney

Results: The male to female ratio was 2.1:1, with a mean age of presentation of 42.70 years. Pain in the lumbar region [58%] was the most common presentation followed by lower urinary tract symptoms [LUTS 32%] and renal insufficiency [16%]. Fever [36%] was the most common postoperative complication. The mean cortical thickness increased to 10.68 mm at third month of follow-up, compared to 9.26mm before surgery. The mean preoperative Hb was 10.84gm/dl. It fell to 10.21 gm at first month of follow-up but increased to 11.89 gm by the third month. . The mean GFR before surgery was 77.18ml/min, which increased to 81.56ml/min after surgery at third month of follow-up. The mean GFR of the kidney with stones was 32.46 ml/min before surgery, which increased to 39.84-ml/ min after surgery

Conclusion: Staghorn stones if left untreated lead to chronic UTI and renal insufficiency. Removal of the stone is the only way these consequences can be avoided. Nonavailability of resources, a poor health care system, the lack of PCNL and ESWL facilities and/or expertise, the cost and need for multiple sessions and/or ancillary procedures in these minimally invasive techniques and the vigorous follow-up required still make open surgery a viable and an applicable option in our socioeconomic setup

Comparison of FNAC and open Biopsy in palpable breast lumps

To compare the results of FNAC and open biopsy in patients presented with palpable breast lump. Comparative study. Nishtar Hospital, Multan, during the period of October 2001 to October 2003. All female patients, irrespective of their age, who presented with breast lump were included in the study. The patients were divided into two groups, group I and II of clinically benign and clinically malignant respectively. Both groups underwent FNAC. The patients with suspicious FNAC were subjected to excision biopsy in group I patients. Group II patients were advised surgery and final report was made on histopathology. Sensitivity and specificity of the FNAC was determined. A total of 89 cases were included in whom both FNAC and histopathology results were available for comparison. Clinically, 54 were benign and 35 were malignant. The cytological diagnosis was unequivocally malignant in 29 patients, suspicious in 3 cases, unequivocally benign in 44 patients and probably benign in 7 patients while specimen was inadequate in 6 patients. Histological diagnosis of these 89 patients showed 55 patients with benign disease and 34 patients having malignant disease. In malignant disease, sensitivity of the FNAC was 85.29% with 100% specificity, 14.7% false negative rate, 100% positive predictive value and 98.79% negative predictive value. FNAC has good sensitivity [85.29%] and very high specificity [100%]. It can replace the open biopsy in majority cases of clinically malignant disease. Although FNAC is slightly less sensitive [80%] in benign diseases, it is highly specific [100%], so it can help to reassure and relieve the anxiety of the patients

Crimean congo haemorrhagic fever [CCHF] outbreak in Karachi

A retrospective investigation was conducted in Karachi during November 2000 to determine the cause of death of a butcher and his contacts who were exposed to the body fluids and vomitus of the butcher while he was being treated at the Aga Khan Hospital, Karachi. The Laboratory analysis of blood samples of HCWs at CDC proved the secondary cases as CCHF infection. This is another example of the risk of nosocomial spread of CCHF in a hospital when health care workers are exposed to the body fluids of a CCHF patient. Case Report: A butcher from Sliah Faisal Colonv Karachi was brought to Aga Khan University Hospital [AKUH]. Karachi with complaints of fever, body aches and bleeding from gums who was admitted on 12th October 2000. He also had severe hematemesis and vomited fresh blood. He was transfused large number of blood bags [approx. 40] 40]. These could possibly be blood products such as whole blood, plasma and platelets. Despite all efforts lie could not survive and died on 16th October 2000. Blood sample of the deceased Nvas not tested for Viral Haemorrhagic Fever [VHF]. Two health care workers [HCW] of AKUH contracted CCHF from index case when they were dealing and clearing tire blood and vomitus from mouth of the index case. One HCW died on November 3. 2000 and another recovered. A team from National Institute of Health [NIH] Islamabad conducted a retrospective investigation to determine the cause of the disease; transmission risks among close contacts; and advised preventive measures to the provincial health authorities and community. The blood samples of both health care workers were confirmed as CCHF positive by CDC Atlanta and the blood samples of mother and wife of the deceased were confirmed as Polymerase Chain Reaction [PCR] negative for CCHF and none of them had IgG or IgM antibodies to CCHF when lab confirmed at National Institute of Virology [NIV], South Africa

Measles mortality among Afghan refugee children

Measles outbreak was investigated in Afghan refugees camp, Haripur, NWFP where around 80 cases of measles had occurred among children of age 1-7 years during a period of two months from December 2000 to January 2001. All the 12 children who died out of the 80 measles cases were residing in a camp served by the Basic Health Unit-3 of the camp. This specific camp had high influx of refugees with low immunization coverage and high malnutrition rate