Liver trauma management: an experience and future directions

Trauma is the leading cause of death in young adults. In Pakistan gunshot injuries, penetrating assault injuries and blunt trauma from road traffic accident are amongst the leading causes compared to UK where blunt trauma from road traffic accident and assault predominate. The liver is the largest solid abdominal organ with a relatively fixed position, which makes it prone to injury being the second most commonly injured organ in blunt or penetrating abdominal trauma. Damage to liver range from sub capsular haematoma to complete avulsion of vascular pedicle. A prospective review of 69 patients who presented between 2002- 2005 in three surgical units. There were 57 [82%] males and 12[18%] females, age ranging from 15-65years were included in this review. There were 33 patients with gunshot wounds, 14 with penetrating wounds, and 18 with blunt trauma. 25 patients had isolated liver injuries and 44 had associated other visceral injuries. The majority of patients were treated with hepatoraphy / debridement except 9 patients who required peri-hepatic packing. Nine patients died. Six patients who were haemodynamically stable were treated conservatively. We advocate use of Ultrasound and CT scan in assessment and non operative management of solid organ injuries in selective patients

Stapled Hemorrhoidectomy: hope or hype!

This study was carried out to assess the feasibility of Stapled haemorrhoidectomy. This included 45 patients of which twenty nine were males and sixteen females. Age ranged from 23 to 84 years. The severity of the disease ranged from 3rd to 4th degree haemorrhoids. Place of study was Sir Ganga Ram, Masood and Wishaw Hospital Scotland. Period of study was two years from October 2002 to October 2004

Frequency and risk factor of abdominal wound dehiscence

To find out the frequency of abdominal wound dehiscence [AWD] in a tertiary care hospital and the assessment of associated risk factors. Design: a cross sectional analytical study. Place and Duration of Study: This study was carried out at Nishter Hospital Multan between May 1998 to May 2000. Subjects and This study was carried out on 406 patients who underwent laparotomy for intra peritoneal procedure and complied with inclusion criteria. Demographic features were recorded and any complications documented. Out of a total of 406 patients, 32 showed wound dehiscence giving an over all frequency of 7.8%. The male to female ratio was 2.8:1. The frequency was greater in males than in females. Majority patients suffered from an underlying malignancy. Malignant intestinal obstruction was the leading cause of wound dehiscence. Forty three patients had hypo-albuminemia[serum albumin <35 gm/l] and 09 of them had AWD. Emergency surgery showed a higher frequency of AWD[12.5%], as compared to elective surgery [18/143 and 14/263 respectively]. Wound infection was a major contributor to AWD as out of 406, 76 patients developed infection and then 21 manifested AWD. older age was also associated with greater frequency. The overall mortality of AWD in this study was 28.1%. AWD still continues to be major post operative complication, with a high morbidity and mortality. The significant risk factors in this study were age more than 55 years, male gender, underlying malignancy, wound infection, jaundice, use of steroids, emergency surgery, uraemia and technique of closure