Intrabiliary rupture of hepatic hydatid cyst: role of ERCP

We report a case of hepatic hydatid cyst presenting with obstructive jaundice following cholecystectomy. ERCP showed intrabiliary cyst rupture with biliary obstruction due to cyst remnants. Endoscopic sphincterotomy was performed and cyst debris removed with complete resolution of symptoms

Biparietal diameter: significant gender difference is present in later weeks of gestation

Objective of this study was to find the presence and significance of difference in biparietal diameter values of male and female fetuses of local population at 35 weeks of gestation. Study was conducted at Lahore General Hospital, and partly in Sir Ganga Ram Hospital/Fatima Jinnah Medical College, Lahore, Pakistan in the year 2005. Outer to inner biparietal diameter in 60 normal singleton fetuses was measured at 35 weeks of gestation. Among them 30 fetuses were male and 30 females. All had comparable values of femur length and fetal abdominal circumference. Mean BPD and standard deviation were calculated for the total, male and female groups separately. Mean BPD in total 60 patients was 87.1 mm, SD2.6. Mean BPD of male group was 88.4mm, SD2, while that of female group was 85.9mm, SD2.4. Lower limit of 2SD range was accordingly different. When lower 2SD limit of male group was used, significant [P<0.05] number [23%] of female fetuses showed BPD<2SD. Using common mean and SD, 13% females showed BPD<2SD, while use of female specific mean and SD showed normal distribution. Biparietal diameter values at 35 weeks of gestation are significantly different in fetuses of each sex. Mean BPD of female fetuses at 35 weeks is 2mm shorter than mean BPD of male fetuses of same age. Male fetuses have a relatively narrow range of normal BPD; and this parameter can be used in males for reliable estimation of gestational age. Females have relatively wider range of normal BPD. Female BPD seems to be responsible for wider range of common nomograms. This parameter alone should not be used for age estimation or diagnosis of small for dates, or microcephaly, in later weeks of gestation in females. Gender specific BPD nomograms may improve the prenatal assessment of fetal growth and structural anomalies

Appendicectomy: non invagination vs. invagination of appendicular stump

To find out the benefits of invagination of stump during appendicetomy. Acute appendicitis is the most common abdominal emergency requiring emergency surgery. A prospective randomized clinical trail. From June 2003 - May 2005. Mayo Hospital and Sir Ganga Ram Hospital, Lahore. A prospective randomized study including 200 patients undergoing appendicectomy was carried out to see any advantage of invagination of appendicular stump. A total of 200 operated cases of appendicitis divided in two groups of 100 cases each. In Group, a there were 59 males and to 2nd and 3rd decade. I Group there were 63 males and females. The youngest patient was 5 year old while the eldest was 57 year old. Maximum patients belonged to 2nd and 3rd decade. It was that there was no added benefit of invagination of appendicular stump, rather it took more operative time, and times, it was hazardous to do so

Peritoneal drainage as definitive therapy in neonates with necrotizing enterocolitis irrespective of wieght and gestational age

To evaluate efficacy of peritoneal drainage[PD] in neonates with necrotizing enterocolitis [NEC] having pneumoperitoneam or peritonitis as a definitive tool of management irrespective of weight and gestational age[GA]. Prospective analysis of 12 cases.This study was conducted in 2 hospital in Taif Saudi Arabia from December2002 to September 2005. All neonates diagnosed as NEC with pneumoperitoneum or peritonitis were included in this study irrespective of weight and GA and peritoneal drainage was performed as a primary tool of management. Pertoneal drainage was performed in 15 patients, but 3 of them were excluded as the cause of pneumoperitonium and peritonitis were other than NEC.Out of 12 neonates 89% improved after PD,only 1[8%] needed surgery.Overall survival was 75%.Main cause of mortality was a second attack of NEC and sepsis. PD is an effective way of treating neonates with NEC irrespective of weight and GA. PD not on ly stabilizez the neonates rather proves to be a definite treatment for the sick premature babies who can not tolerate general anesthesia and surgical stress.Mortality rate is high with second attack of NEC

Childhood intussusception

In a retrospective study, 38 patients with intussusception presenting to paediatric surgical emergency were studied. The objective was to review the management of childhood intussusception and identify factors that require attention for improved outcome. Out of 38 children 26 were males and 12 were females. Age ranged from 2 months to 10 years. Presenting features were mainly vomiting, abdominal pain/excessive crying, abdominal distension, passage of blood and mucus in the stool and a palpable abdominal mass. Duration of symptoms i.e., time period lapsing between the onset of symptoms and seeking the treatment was < 24hours in 21.3% cases, 24-72 hours in 3l.5% > 72 hours in 39.4% and > 1 week in 7.8% cases. Ileo-colic intussusception was found in 76% cases, colo- colic in 16 and ileo-ileal in 8% cases. Manual reduction was successful in 34% cases and resection of the gut had to be done in 66% cases. Delay in diagnosis was associated with increased morbidity and mortality. The authors recommend that prompt treatment is the key to reduce the morbidity and mortality

Minilap cholecystectomy

A retrospective review of 292 consecutive minilap cholecystectomies carried out in one surgical unit of Combined Military Hospital Rawalpindi during 1993-1995, is presented. A different technique was used. we employed a 4 cm subcostal transverse incision. Anterior rectus sheath was incised longitudinaly, right rectus abdominus muscle was retracted laterally and posterior sheath and peritoneum incised transversely. The conversion to midline incision was 3% [9 patients]. An average hospital stay was 2 days. Follow-up is recorded by information gained through postal questionnaires. The complication rate was 4%. No patient has yet reported with incisional hernia. One patient died due to septicaemic shock.

Minilap cholecystectomy is safe and effective alternative to laparoscopic cholecystectomy. It requires no special training or expensive equipment. These advantages translate into decreased hospital expenses and reduced hospital health care cost

Late presentation of carcinoma breast in Pakistan women

Carcinoma of the breast is one of the commonest malignancies in women worldwide. Patients in our country usually present late with advanced disease. This study was conducted to delineate the reasons for this late presentation and its impact on the management and prognosis. Delay in presentation was attributed by 73 152.5%] to painlessness of the lump. Sixty-seven patients[48.2%] were afraid of surgery in general while 46133%] were scared of losing the breast. Non availability of a female doctor was cited as a delaying factor by 64 [46%] patients. Lack of education per se was not a significant factor in late presentation as 129 of 139 patients [92.8%] were literate with only 10 [7.2%] being totally illiterate. Fifty one [36.8%] had completed intermediate or higher level of education. Increasing parity was another factor for delay with 12 of 15 [80%] of the nulliparae presenting within one month while only 5 [9.2%] of the 54 women with 4-8 children presenting in this time period. The delay in presentation was found to have a direct brearing on the stage of the disease. 58 patients [31.2%] reported within one month of the onset of symptoms and 22.8%] were in clinical stage-I. 91 patients [48.9%] presented between 1-6 months of the onset and only 7 [3.7%] were in stage-I of the 36 patients [19.3%] who presented after 6 month there were non in stage-I or stage-II