Ruptured infected femoral pseudoaneurysm in iv drug abusers ligation under local anesthesia

Background: IV drug abusers usually present with life threatening hemorrhage from ruptured infected femoral pseudoaneurysm in emergency. Back up of family, friends and resources are marginal with these patients. In literature many procedures from simple debridement to extra anatomic bypass have been reported

Objective: To assess the outcome of ligation of external iliac artery under local anesthesia in terms of survival, limb salvage and feasibility

Methodology: This cross sectional study was conducted in Department of Surgery, Quaid e Azam Medical College, Bahawalpur. Duration of study was five years from 1st December 2010 to 31st December 2015. All patients presenting with bleeding or ruptured femoral pseudoaneurysm in this time span were admitted. Pressure dressing over bleeding aneurysm was done; wide bore peripheral IV line/CV line was passed; fluid resuscitation was started; broad spectrum antibiotics were injected; request for blood arrangement sent and necessary investigations were sent; special consent was taken. Local Anesthesia was injected in the groin just above the aneurysm ketamine given their needed. External iliac artery was explored in supra inguinal position and ligated. Data regarding age, gender, drug of abuse, vascular status of the limb, need for blood transfusion during procedure, life safety, limb salvage was analyzed. Data was entered and analyzed by using SPSS version 20

Results: We ligated external iliac artery just proximal to aneurysm in 48 patients under local anesthesia. Life and limb was saved in 43 [89.5%] patients. Five patients [10.5%] required above knee amputation later

Conclusion: Ligation of external iliac artery under local anesthesia in ruptured pseudo aneurysms is simple and safe

Intra-abdominal pathologies

To evaluate relative frequency, reasons, avoidable responsible factors and outcomes of relaparotomy. Observational case series study. Department of Surgery Unit III BVH Bahawalpur. From 01-9-2009 to 31-8-2010. All the patients who presented in surgical outdoor, indoor and casualty department with severe intra-abdominal pathologies after primary laparotomies referred from low level, secondary care and tertiary care hospital and underwent relaparotomy electively or on demand were included in the study. Retrospectively their demographic characteristics, initial diagnosis with surgical information of primary laparotomy, factors and outcomes after relaparotomies were analyzed statistically. A total 54 patients were included in the study with male to female ratio of 1:2. Mean age of the study group was 30.91 +/- 12.5 years. Relative frequency of relaparotomy was 5.6%. Common center of referral was low level hospital 66.7%. Most common indication of relaparotomy was peritonitis in 52%. Most common complication of relaparotomy was wound infection 74%. Avoidable factors responsible for relaparotomies were found to be surgery at low level hospitals [77.3%] and by nonqualified surgeons [72.1%]. The rate of relaparotomy is very high because of unsupervised primary surgery in institutions and surgery by unqualified operators in private sector. Many of these are avoidable. In addition to decreasing the complication rate, primary surgery performed at tertiary care hospitals would decrease need for patients to undergo re-exploration

Correlation of hepatic venous pressure gradient with variceal bleeding, size of esophageal varices, etiology, ascites and degree of liver dysfunction in cirrhosis of liver.

An elevated hepatic venous pressure gradient (HVPG) has been associated with risk of variceal bleeding, and outcome and survival after variceal bleeding. In this pilot study, we measured HVPG in 40 patients with liver cirrhosis and studied its relationship with etiology of liver disease, esophageal variceal size, history of variceal bleeding or ascites, biochemical liver tests and Child-Pugh class. There was no procedurerelated complication. The mean (SD) HVPG was similar in patients who had history of variceal bleeding as compared to those who did not (15.4 [2.8] mmHg vs. 13.9 [2.7] mmHg, p=0.1); HVPG had no significant association with etiology of cirrhosis (p=0.4). HVPG levels were significantly higher in patients with larger esophageal varices (grade III/IV vs. I/II: 15.2 [2.7] mmHg vs.13.1 [2.8] mmHg, p=0.04), poorer Child- Pugh class (B or C versus A), and presence of ascites (p=0.04). Thus, HVPG correlated with variceal size, Child-Pugh class, and presence of ascites, but not with variceal bleeding status.

Pilonidal sinus: prevalence and comparison of excision and primary closure with lay open procedures

To study the prevalence of pilonidal sinus and compare the outcome of the excision and primary closure with lay open surgical procedures. Prospective randomized comparative study. Department of surgery, Bahawal Victoria Hospital Bahawalpur. From 1st December 2002 to 30th November 2007. A total of 40 patients with pilonidal sinus were randomized into two groups. Group I underwent excision and primary closure while Group II underwent excision and lay open procedure. Patients of Group I and II had comparable mean operation time of 42.7 minutes. Group I patients had a shorter mean hospital stay of 4.87 days, earlier return to light work after 13.21 days, less treatment expenses and low rate of postoperative complications and good patient satisfaction. We conclude that primary closure after excision of pilonidal sinus is superior surgical procedure than excision and laying it open

Parotid swelling in children; our experience at department of paediatric surgery B.V.

To describe the clinical and pathological presentation as well as treatment options of parotid swelling in children. Descriptive case series study. Department of Paediatric Surgery Bahawal Victoria Hospital Bahawalpur. From Nov 2005 to Jul 2007. All patients of either sex below the age of 13 years presenting with parotid swelling were included in the study. Clinical presentations, preoperative investigations, operative procedures, histopathology reports, postoperative complications and further management [radiotherapy and chemotherapy] were recorded. Twelve patients presented with parotid swelling. Commonest presentation was a lump over the parotid region [100%] and pain [25%]. Majority of tumours were benign [50%]. Vascular lesions outnumbered solid tumours. 4 patients [33.33%] had haemangioma 1 patient [8.33%] had cystic hygroma, one patient each of pleomorphic adenoma, mucoepidermoid carcinoma and Adenocarcinoma. Salivary gland lesions are most likely inflammatory in origin. Vascular tumours are common benign tumours than epithelial tumours in children. Superficial parotidectomy is the operation for benign tumours and total conservative parotidectomy for malignant tumours

Tuberculosis; determinants of treatment non-compliance among T.B. patients

To identify the factors responsible for noncompliance of Anti Tuberculous Treatment in TB patients. Cross Sectional Descriptive Study. The study was Carried out at Chest diseases and Tuberculosis unit Bahawal Victoria Hospital Bahawalpur from 15th May 2007 to 15th August 2007. The tuberculous patients who abandoned anti-tuberculous treatment repeatedly were interviewed for determination of their reasons to be defaulter before completing therapy by questionnaire method. The patients were AFB positive on every non-compliance episodes. The total number of 100 noncompliant patients were interviewed. It was noted that 63% were males and 37% were females among them. There were 72% married and 28% unmarried from total patients. The treatment source was asked and found that 92% used government health out let only and 8% used private services also from them. TB is curable disease so health education should be imparted through electronic media and committed field teams stressing to take regular and complete ATT according to the physician advice removing the social belief against TB drugs. Decentralized government and private sector coordination is essential to give treatment at doorstep to reduce dropout and defaulter tendency. Stigma of TB as a disease of the illiterate and poor still persists

Unusual presentation of carcinoma of penis

A case of carcinoma of the penis in a 55-year-old landlord is described. He presented with a fungating growth on the shaft of his penis with an unusual history. The lesion started as a nodule in the coronal sulcus leading to thinning of urinary stream and ultimately retention of urine, which was diagnosed and treated as a case of urethral stricture. Wedge biopsy of the growth revealed the case of squamous cell carcinoma of penis. Ultrasonography and CT scan of pelvis and abdomen proved the disease to be localized to penis and total penectomy was carried out

Prognostic factors for locoregional recurrence of breast cancer

To explore prognostic factors for locoregional failures among women treated for invasive breast cancer by surgery and adjuvant therapies. Design: Descriptive study. Place and Duration: The study was conducted at the Surgical Department, Bahawal Victoria Hospital [BVH], Bahawalpur with mutual cooperation of Bahawalpur Institute of Nuclear Medicine and Oncology [BIND] over a period of five years. Patients And The study consisted of 120 women who were treated with a modified radical mastectomy [85 at BVH and 35 at various district and private hospitals] and enrolled for an adjuvant therapy. A total of 25 patients of breast cancer with node negative disease received either no adjuvant therapy or a single cycle of perioperative chemotherapy, and 95 women with node positive disease received adjuvant chemotherapy of at least 5 months duration and/or tamoxifen for at least one year. Mean follow up was 4.2 years. In women with node negative disease factors associated with increased risk of locoregional failure were vascular invasion [VI] and tumor size greater than 5 cm for premenopausal and VI for postmenopausal patients. Of the 25 patients, 6 [24%] met criteria for the high risk groups. For the node positive group of patients number of nodes and tumor grade were factors for both menopausal groups, with additional prediction provided by VI for premenopausal and tumor size for postmenopausal patients. Of the 95 patients, 34 [35.8%] met criteria for the high risk groups. Locoregional recurrence is a significant problem after mastectomy alone even for some patients with node negative breast cancer, as well as after mastectomy and adjuvant treatment for some subgroups of patients with node positive disease. In addition to number of positive lymph nodes, predictors of locoregional failures include tumor related factors, such as microscopic vascular invasion, higher grade and larger size

Thyroidectomy for a giant goitre

This is a report of a giant nontoxic, multinodular nonmalignant goiter who underwent subtotal thyroidectomy by us. It weighed 2.5 Kg after removal. In view of the profuse vascularity of the thyroid we initially ligated the external carotid arteries on both sides. Prophylactic tracheostomy is mandatory after this operationfor 4-5 days