Is laparoscopic cholecystectomy a safe treatment option in empyema of gall bladder?

To find out the effectiveness and safety of laparoscopic cholecystectomy for treatment of empyema gallbladder. Quasi-experimental study. PNS Shifa Karachi and CMH Lahore, Pakistan from January 2010 to August 2013. Out of 493 patients who underwent laparoscopic cholecystectomy [LC] by a single consultant surgeon during the study period, 40 patients who had empyema gall bladder on laparoscopic findings were included in the study. All patients with diagnosis of acute cholecystitis [n=117] who had no pus present in gall bladder and patients with diagnosis of biliary colic or chronic cholelithiasis [n=336] were excluded from the study. Forty patients were diagnosed to have empyema gall bladder. LC was successfully completed in 39 patients [97.5%]. In one patient [2.5%] the procedure was converted to open cholecystectomy [OC] due to finding of cholecystoduodenal fistula on laparoscopy. Mean operating time was up to 58.62 +/- 26.33 minutes. Postoperative complications occurred in 3 [7.5%] of the operated patients. Mean duration of hospital stay was 1.7 +/- 2.09 days. One patient with co-morbidity of diabetes mellitus died of septicemia resulting in a mortality rate of 2.5%.In laparoscopy for empyema gallbladder the complications are related to the advanced disease process and not to the approach. In skilled hands, laparoscopic cholecystectomy can be performed successfully in patients with diagnosis of empyema gallbladder

Mycetoma foot

Mycetoma is an uncommon chronic granulomatous infective disease of the skin, dermis and subcutaneous tissues predominantly seen in tropical countries. A patient presented to our hospital with the swelling of the left foot with a healed sinus and a painful nodule. He gave a history of sinuses in the left foot from which there was discharge of yellow granules. Culture of the ultrasound guided fine needle aspiration cytology of the nodule revealed growths of Nocardia species. The patient was treated with a multi-drug therapy along with debridement of the painful nodule. He experienced symptomatic relief and a regression of the swelling within the three months of follow-up so far. Due to the relatively slow progression of the disease, patients are diagnosed at a late stage. Hence, emphasis should be placed on health education and the importance of wearing footwear