Pattern of injuries in trauma patients presenting in accident and emergency department of Jinnah Hospital, Lahore

To observe the pattern of injuries in patients involved in different kinds of trauma presenting to the Accident and Emergency Department of Jinnah Hospital Lahore. A prospective descriptive epidemiological study. Accident and emergency department of Jinnah Hospital Lahore. From 1st April 2005 to 30th September 2005. The study included patients presenting with different kinds of trauma to the emergency department of Jinnah Hospital, Lahore. They were further categorized into trauma of different regions of the body i.e. upper limb, lower limb, abdomen, head and neck, thorax and perineum. Then frequency of different types of trauma was determined. During this period [1st April2005 to 30th September 2005], 111'413 patients presented in accident and emergency department and 4680 patients had traumatic injury. 1404 patients [30%] had blunt trauma, 134[2.86%] had penetrating firearms injury, 2433[51.99%] had penetrating sharp injury an d 709 patients [15.15%] had crush injury. Most patients got upper limb, lower limb, head and neck and abdominal injuries, in that order. Most patients received multiple injuries. 3340 patients [71.36%] got only minor surgery like stitching under local anaesthesia and 468 patients [10%] had no surgery at all. 872 patients [18.63%] underwent some kind of major surgical procedure like amputation, exploratory laparotomy, or stitching under GA etc. Trauma is a leading cause of morbidity and mortality among all age groups. Most of the trauma victims receiving minor injuries can be treated at primary heath care centers. This can decrease the load of tertiary care hospitals. Maximum impact in reducing the burden of trauma must come from injury prevention strategies

Ivor Lowis esophagectomy: experience at Jinnah hospital, Lahore

Although different approaches have been used for surgical resection of esophageal cancer, the Ivor Lewis approach is the standard technique at most centers for resection of the diseased middle and lower third esophagus. This procedure has historically been associated with significant morbidity and mortality. However, modern literature suggests that Ivor Lewis esophagectomy can be performed with an acceptable complication rate and mortality. Patients and methods: We conducted a case series of thirteen consecutive patients who underwent an Ivor Lewis esophagectomy at Jinnah Hospital Lahore from January, 2001 to December, 2002. The objective was to examine the morbidity, mortality and short-term outcome of this surgical procedure. The mean age of the patients was 45.9 years +/- 18.3 years [median: 44.5 years; range: 22 to 78 years]. 7 patients were men and 6 patients were women. 6 patients [46.2%] were operated for benign corrosive esophageal strictures whereas seven patients [63.8%] had esophageal cancer. The median age of the patients with benign strictures was 28 years [range: 20 - 35 years]. The median age of the cancer patients was 58 years [range: 54-70 years]. Of these patients, one had Stage I cancer [9.29%], two had Stage II a [28.57%], two had Stage II b [28.57%], and two had Stage III disease [28.57%]. Five patients [71.42%] had adenocarcinoma and two [28.57%] had squamous cell carcinoma. Seven patients [53.8%] had one or more co-morbid conditions, including diabetes, hypertension, cardiovascular disease and chronic obstructive pulmonary disease. Four patients [30.77%] had history of smoking. The mean operative time was 270 minutes +/- 31 minutes. The mean operative blood loss was 1500 ml +/- 102 ml. The median ICU stay was one day [range: I to 7 days]. The median hospital stay was 19 days [range: 15 to 38 days]. Eight patients [61.54%] developed post-operative complications. Most of these complications were medical [60%] rather than surgical [40%]. Respiratory complications were the commonest [30.77%]. Of the surgical complications, the most common was the development of an anastomotic leak [23.08%]. All of these were managed conservatively and none proved fatal. There were two mortalities on post operative days 7 and 8, due to ARDS and multi-organ failure respectively. The operative mortality was 15.39%.Ivor Lewis esophagectomy represents a major physiological and surgical insult. However, careful patient selection, perioperative monitoring and early aggressive treatment of complications can significantly reduce morbidity and mortality

Is breast cancer in younger women a more aggressive variant? a comparative study

Breast cancer is the commonest malignancy in women in the world. About 5% of all breast cancer patients are 35 years old or younger. Current literature suggests that breast cancer in these younger women may be different in etiology, clinical features and outcome from the disease seen in older women. We included all breast cancer patients who underwent surgical treatment at Surgical Unit IV, Jinnah hospital, Lahore from December, 1998 to December, 2003. All patients who left against medical advice or were lost to follow up before completing treatment at our hospital wee excluded. The patients were divided into two groups by age. Those who were 35 years old or younger were placed in group 1 [88 patients] and those older than 35 years were placed in group 11[54 patients], which served as the control group. We compared the clinical presentation, the risk factor profile, and the grade and the stage of the tumor at presentation in younger women and their older controls. The mean age in group I was 29.38 years +/- 3.68 years. While the mean age in group II was 44.41 years +/- 7.64 years. The commonest mode of presentation in both groups was a painless lump. [93.2% in group I and 66.67% in group II; p value < 0.001]. The distribution of classical risk factors was similar in the two groups. These included family history [12.5% in group I and 11.1% in group II], nulliparity [7.95% in group I and 7.4% in group II], and oral contraceptives use[14.77% in group I and 12.96% in group II]. Younger patients presented with a greater number of poorly differentiated [Grade III] tumors compared to the older patients. [73.76% vs.24.07%; p value <0.001]. They also presented more frequently with hormone insensitive tumors [79.55% in group I vs. 24.52% in group II; p value < 0.001]. Mammography was positive more often in older women compared to the younger ones [97.44% vs.41.38%; p value < 0.001]. Ultrasound was done in 67.05% of the younger women and 27.78% in the older women. It was suggestive of malignancy in 89.83% of the younger women and 86.67% of the older ones. Modified radical mastectomy was done in 75% of the younger patients [Group I] and 61.11% of the older patients [Group II]. Radical mastectomy was done in 19.32% of group I patients and 27.78% of group II patients. Older women underwent breast conservation treatment more often than the younger women [11.11% vs. 5.68%; p value < 0.05] Adjuvant chemotherapy was given more often to younger women [73.86% in group I vs. 9.26% in group II; p value < 0.0001]. On the other hand, older patients received hormonal therapy more often that the younger ones [74.07% vs. 20.45%; p value < 0.001]. Younger patients also received adjuvant radiotherapy more frequently than their older counterparts [84.32% vs. 49.26; p value <0.05]. We conclude that women with breast cancer who are 35 years old or younger have more aggressive tumors than the older patients i.e. they present at a higher stage with poorly differentiated tumors that are frequently hormone insensitive

Incidence of urinary tract infection during pregnancy

Incidence of urinary tract infection [UTI] during pregnancy among Pakistani women was examined. Midstream urine was collected from 250 pregnant and 100 control women and streaked on blood agar and incubated. Growth was considered significant if > / = 10[5]/mL bacteria were present. Among the pregnant women, 28.5% had UTI; 30.0% of controls had UTI. Among the pregnant and control women, 24.4% and 20.0% respectively had UTI symptoms, such as incontinence, nocturia and urgency. Symptoms did not correlate with incidence. Socioeconomic status, personal hygiene, education level, pregnancy duration, postcoital washing, contraceptive use and use of underclothing had no significant association with UTI occurrence. A history of past urological problems was associated with an increased incidence of UTI in pregnancy