Correlation of anterior chamber depth with peripapillary nerve fiber layer thickness

Objective: To determine correlation of anterior chamber depth with peripapillary nerve fiber layer thickness. Study Design: Descriptive cross sectional study. Place and Duration of study: Armed Forces Institute of Ophthalmology Rawalpindi, from Apr 2016 to Oct 2016

Patients and Methods: Anterior chamber depth and peripapillary nerve fiber layer thickness was measured in 200 eyes of 110 patients, between 10-40 years of age. Anterior chamber depth was measured in mm, by taking average of 3 readings, measured by optical biometry [IOL Master, Carl Zeiss Meditec, Dublin whereas average peripapillary retinal nerve fibre layer pRNFL thickness was obtained by taking average of 12 segments RNFL thickness measurement, calculated by Spectral domain optical coherence tomography [SD OCT] [3D OCT-1000 Markll, Topcon Co, Tokyo, Japan] after dilating pupils with one drop of 1% Tropicamide, instilled three times, 10 minutes apart. Three readings were taken for each eye. The mean of the three readings was used for the analysis. Pearson correlation [+1/-1] was calculated between anterior chamber depth, peripapillary nerve fiber layer thickness and age

Results: Two hundred eyes of 110 patients were included in the study. Both eyes were considered in 90% of the patient, however only Right eye was considered in 6.3% of the patients while left eye in 3.7% of the patients. Mean age of the patients was 26.58 +/- 8.88 years. Mean visual acuity of patients measured by log MAR was 0.52 +/- 0.12. Mean Anterior chamber depth [ACD] of patients was 3.41 +/- 0.35 while mean RNFL appeared to be 103.26 +/- 8.89 um

Conclusion: It was concluded that anterior chamber depth was neither related significantly with peripapillary nerve fiber layer nor with age

Effectiveness of gastrografin in resolving small bowel obstruction

Objectives: To determine the effectiveness of Gastrografin in resolving intestinal obstruction

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted in the Department of Surgery, Shaikh Zayed Hospital, Lahore from 02-10-2013 to 02-04-2014

Materials and Methods: One hundred thirty five patients who having small bowel obstruction were admitted through out-patient, accident and emergency departments. Every participant was explained about both procedures and their consequences

Results: Average age was 44 +/- 70 years. 77 [57%] were males and 58 [43%] were females with a male to female ratio was 1.32:1. In 58 [43%] male patients the obstruction was resolved, but in 19 [14%] male patients obstruction was not resolved. In 41 [30%] female patients the obstruction was resolved and in 17 [12%] female patients the obstruction could not be resolved. Overall, in 99 [73%] patients, the obstruction was resolved but in 36 [27%] of patients the obstruction was not resolved

Conclusion: Gastrografin is a secure and reduces the need for surgery when conservative treatment fails. It remains a leading cause of hospital admission in surgical departments

combined role of alvarado score and ultrasonography for the diagnosis of acute appendicitis

Objectives: Objective of the study was to evaluate use of Alvarado score and ultrasonography in diagnosis of acute appendicitis

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Department of Surgery along with Department of Radiology at Shaikh Zayed Hospital Lahore from 1[st] January 2013 to 31[st] August 2013

Materials and Methods: 250 patients of Alvarado Score were enrolled for the diagnosis of acute appendicitis attending out-patient, accident and emergency departments

Results: There were 184 [74%] were males and 66 [26%] were females with mean age of 35.27 +/- 12.57 years. One hundred and seventy patients had anorexia while 76 patients had no anorexia. 49.6% patients while in 50.4% were reported anorexia. Right iliac fossa was noted in all patients. 95% patients had rebound tenderness 203 patients have elevated temperature

Conclusion: Alvarado score is a simple and reliable non-invasive diagnosis modality without any extra cost and complication. It has also proved to be handy for our peripheral hospital settings where backup facilities not available. By application of Alvarado scoring system with non-invasive ultrasonography improves diagnosis accuracy by reducing negative appendicectomies hence reducing complications rate in our settings

Pre-analytical errors in a peripheral hospital laboratory

To analyse pre-analytical errors which account for the major contribution towards laboratory errors. Cross-sectional descriptive study. Combined Military Hospital Kohat, Pakistan from 1[st] January to 30[th] June 2012. For six months laboratory staff was asked to register rejections and causes for rejection of all samples; including in-patient samples from wards as well as out-patient samples collected in the laboratory. In addition all samples where disparity was noted by the clinicians in the laboratory results were also included for analysis. Suspected samples were reanalyzed, tests were also repeated on fresh samples of the patients and a critical appraisal was made. Among a total of 328418 analyses, clinicians/laboratory staff notified 350 questionable findings, 270 of which were confirmed errors. Out of total 270 errors, 77% were pre-analytical, 8% were analytical, 15% were post analytical errors. Out of total pre-analytical errors 8% were incorrect samples, 21% were misidentifications, 51% were faulty sampling techniques and 20% were incomplete/illegible laboratory request forms. The pre-analytical phase in the total testing process currently appears to be more vulnerable to errors than the other phases. Consequently, the pre-analytical phase should be the main target for further quality improvement. Therefore identifying the critical steps in the pre-analytical phase is a prerequisite for continuous quality improvement, further error reduction and thus for improving patient safety

Mesh versus non-mesh repair, eleven years experience at Shaikh Zayed Hospital, Lahore

Ventral Incisional Hernias are a well known complication after abdominal surgery with a reported incidence of 10% - 20% and a recurrence rate of 30% - 50% after open suture repair and less than 10% after open mesh repair. To compare the outcome of two different methods of open repair of VIH [i.e. Mesh versus Non-mesh or Suture Repair in terms of morbidity, complications and recurrence. 11 years period [January 2000 - December 2010]. Shaikh Zayed Hospital, Lahore. The total number of patients who underwent surgery for repair of VIH during the study period was 321.There were only 33 patients in Group A [simple suture/Keel repair] while Group B had 288 patients. The most common early postoperative complications seen in both the groups were wound seroma and infection. Post-operative respiratory insufficiency was more common in the obese. Chronic pain and feeling of foreign body was more frequently seen in the mesh group. On the other hand, recurrence rates were far greater in the suture repair group. The overall mortality in the whole series was 3 patients [0.93%]. The rates of ventral incisional hernia recurrence and complications are significantly lower after open onlay mesh repair as compared to the open suture repair. However, these results require confirmation by prospective randomized clinical trials which should also include the results of laparoscopic ventral incisional hernia repair which is a new and emerging technique in Pakistan

Retroperitoneal lymphangioma

Retroperitoneal lymphangioma is a rare benign congenital malformation of lymphatic channels. This report is of a 35 years old male who presented with 1 month history of abdominal pain and swelling due to a large retroperitoneal cystic lymphangioma. The lesion was removed surgically with complete resection

Pleomorphic rhabdomyosarcoma within a choledochal cyst; a rare cause of obstructive jaundice

Bile duct cysts are rare and of uncertain origin. Most have been reported in young females of Asian Descent. The long term complication of choledochal cysts includes malignant transformation in the epithelial lining of biliary tree. Histopathologically it is Cholangiocarcinoma in the majority of cases with poor long-term prognosis. However, Rhabdomyosarcoma associated with choledochal cyst in an adult is rarely reported before. The authors report one such case in an adult female patient who presented to us with features of obstructive jaundice

study of gynaecological emergencies presenting as Acute Appendicitis

To assess the frequency of gynaecological emergencies presenting as acute appendicitis among females of child bearing age. Descriptive analytical study. The study was conducted at the surgical unit-II of Sheikh Zayed hospital and postgraduate medical institute Lahore from January 2000 to December 2000. The study included 105 female patients aged 15-45 presented in accident and emergency department with right iliac fossa pain. Diagnosis was clinical in all cases .Investigations for leukocyte count, pregnancy test and lower abdominal ultrasound scan were used to improve diagnostic accuracy. All diagnosed patients underwent appendectomy and intra-operative findings were recorded. Patients with gynaecological disorder were dealt accordingly. Final diagnosis of acute appendicitis was made on Intra-operative findings and histopathology report. There was high frequency of gynaecological disorders simulating acute appendicitis in the age group ranging 15-25 years with mean age 23.1 and standard deviation + 0.74. Duration of pain ranges from 12 hours to 4 days. Pain and tenderness in right iliac fossa was found in all patients where as shifting of pain was present in 61% of cases. Total leukocyte count more than 11000 per cubic millimeter was present in 60% cases. Peroperatively acutely inflamed appendix was found in 71.4% ruptured ovarian cyst in 11.4%, right tubal abortion in 0.9% and pelvic inflammatory disease in 4.7% of patients. Histopathological report revealed that in 77.1% of cases appendix was acutely inflamed. Thus out of 105 study subjects who underwent appendectomy, 18[17%] were having gynaecological problems. In 3[2.8%] mesenteric lymph node biopsy was done, which turned out to be chronic nonspecific inflammation. In 9[8.5%] no positive finding could be found preoperatively. The rate of negative appendectomy in our study was 22.9%. There is considerable number of young females with gynaecological disorders presen ting in emergency as acute appendicitis. Good clinical judgment and routine use of ultrasonography is desirable to reduce the negative rate

Critical factors in determining mortality from penetrating abdominal vascular trauma: the Mayo Hospital experience

Mayo Hospital Lahore is a big and busy trauma center in Pakistan that receives a substantial number of patients with penetrating abdominal trauma. Vascular injuries in these patients are not uncommon. They are difficult to repair and are usually associated with a high mortality. The purpose of this study was to review treatment principles, complications and factors affecting the outcome variables in our setup in these cases, the main outcome variable being survival. Complete medical records of 411 patients with penetrating abdominal injuries, operated in our emergency over a four years period [January 1996 - December 1999], were reviewed. Amongst these 57[13.86%] had significant abdominal vascular injuries. The commonest afflicting agents were firearms [81%]. The overall mortality was 31.5%. The highest mortality was associated with retro-hepatic vena caval injuries [66.6%]. Very high mortality rates were seen in patients who were admitted with un-recordable blood pressure [72.2%] and in patients who had combined arterial and venous injuries i.e. more than one abdominal vascular injury [42.8%]. Mortality seems to be directly related to the site of the vascular injury [high for supra-renal / retro-hepatic vena caval injuries], the presence of shock on admission, free bleeding and the lack of retro-peritoneal tamponade at the time of surgery, and the presence of additional vascular injuries. The major cause of death in our patients was profound shock due to uncontrolled bleeding. Early diagnosis, prompt intervention and effective management could result in improved salvage rates

Extremity vascular trauma-the continuing challenge

A retrospective study of 36 consecutive patients with extremity vascular trauma managed by the South Surgical Ward trauma team between February 1998 to January 2000. All our patients were men with a mean age of 27 years. The commonest clinical presentation.was with haemorrhage [75%] or ischemia [58.4%]. The mode of injury was gunshot wounds [75%], blunt trauma [20%] and iatrogenic injuries [5%]. The most commonly injured arteries were the superficial femoral [27.5%], the popliteal [24%] and the brachial [24%]. The techniques utilized for.repair of the arterial injuries were autogenous reverse vein grafting [51.7%], end-to-end anastomosis [27.6%].and lateral repair [3.4%]. 17.2% of the arterial injuries were ligated. 43% of the venous injuries underwent lateral venorrhaphy while 57% were ligated. Tri-compartment leg fasciotomies were carried out in 14 patients The commonest complication was vein graft thrombosis [16.7%]. Our amputation rate and mortality were both at 6.9%. Early transport of the patient to a good surgical facility, good surgical judgement and the liberal use of. vein grafts improves the outcome in vascular injuries of the extremities