Frequency of gall bladder carcinoma in patients undergoing surgery for cholelithiasis

To determine the frequency of gall bladder carcinoma in patients undergoing surgery for cholelithiasis at Isra University Hospital, Hyderabad, Singh- Pakistan. This was a descriptive study, conducted from April 2006 to March 2008 at Isra University Hospital Hyderabad, Pakistan. This study included 200 cases of cholelithiasis who underwent cholecystectomy at out Hospital. Patients belonged to both sexes having cholelithiasis, diagnosed on the basis of clinical grounds and supported by ultrasonography. A uniform procedure of history taking, physical examination, investigations and treatment was adopted for all the patients, and data were recorded on the pre-designed proforma. Of 200 cases that were operated for gall bladder stone disease, eight were found to have carcinoma of gall bladder i.e. frequency was 4%. The age ranged from 35 to 70 years, with mean 50[ +/- 5.3] in females and 56[ +/- 2] in males. Male to female ratio was 1:3. On ultrasound, only three [37.50%] patients with advanced disease had a pre-operative clue of carcinoma. The frequency of gall bladder carcinoma in our population seems much higher than Western populations. Females are more affected than males by this problem. Ultrasonography can miss malignant lesions; therefore every gall bladder specimen should be subjected to histopathology. While in unsuspected cases undergoing laparoscopic cholecystectomy, gentle handling of the gall bladder is critical to avoid port site implantation caused by spillage of bile

Association of gallstone disease risk with serum level of alkaline phosphatase

To see the relationship between personal history and blood chemistry of preoperative gallstone patients with gallstone disease. A Cross sectional study. Liaquat University Hospital Jamshoro for a period of three years. Gallstone patients admitted for the treatment during January 1999 to December 2001 were studied with the help of a predesigned proforma for recording the personal history and blood chemistry results of the individual patients. A total of 172 patients was studied. Majority [85.33%] of the gallstone patients was females. Females under 45 years age [65.38%] and females having more than three children [70.55%] were more prone to develop gallstones than the respective female group of over 45 years age [34.62%] and having upto three children [29.45%]. Past history of the gallstone patients revealed that 53.5%, 23.2%, and 9.3% of the cases had jaundice, diabetes mellitus and renal stones respectively. Blood chemistry of the patients showed that 18.2%, 2.8%, 3.44% and 4.1% had respectively hyperbilirubinemia, hyperuremia, hyperglycemia and hypoglycemia. Alkaline phosphatase and alanine aminotransferase levels in plasma and total leuckocyte count in blood were raised in 17%, 39.7% and 9% cases respectively. However, low plasma alkaline phosphatase levels were also found in 31.1% gallstone patients. The levels of plasma alkaline phosphatase were significantly high [p<0.01] in females than in males, and in females over 45 years age than under 45. Risk of gallstone disease in females is associated with serum alkaline phosphatase level

Carcinoma stomach. a thrapeutic challenge

A five year retrospective study was carried out in Surgical Unit - IV Liaquat Medical College Hospital Jamshoro. The cases of carcinoma stomach admitted from January 1993 to December, 1997 were included in the study to determine the clinical presentation and treatment of gastric cancer. Duration of symptoms were less than six months in 70 percent cases. Abdominal pain [60 percent], vomiting [54 percent], peptic ulcer symptoms [50 percent], GIT bleeding [36], dysphagia [36 percent] weight loss [40 percent] palpable mass [48 percent], ascites [34.3 percent] and hepatomegaly [42.8 percent] were the main clinical presentations. Out of 50 cases 35 were operated, 15 being unfit for the operation. Out of 35 cases no procedure could be performed in 15 cases due to advanced stage of disease. Palliative gastrectomy was performed in 10 and curative surgery in another 10 cases. Duodenal leakage [14.3 percent], bleeding [11.43 percent], wound infection [8.5 percent], UTI [17.14 percent] and small bowel obstruction [2.83 percent] were major complications. Upper GIT endoscopy for early diagnosis of carcinoma of stomach is essential especially before starting treatment for peptic ulcer symptoms

Choledochoduodenostomy in the management of choledocholithiasis

A two years study from January 1993 to December 1994 was carried out to determine the safety and effectiveness of Choledochoduodenostomy as the definitive treatment of Choledocholithiasis. A total of 30 patients underwent the operation. In 22 cases the Choledochoduodenostomy was done alongwith cholecystectomy and 8 patients had cholecystectomy / CBD exploration done previously. At the time of admission 83.3% patients had pain, 46.7% had jaundice, and 50% had past history of jaundice. Fever with rigors was present in 46.7% cases and at operation common bile duct diameter was less than 2cm in 20 cases and more than 2 cm in 10 cases. Post operative wound infection occurred in 26.7% cases, 10% developed cholangitis and 2 [6.7%] had leakage from anastomosis out of which one patient [33.3%] died

Two years study of surgical treatment of carcinoma rectum

A prospective study of 30 patients of carcinoma rectum was carried out at Liaquat Medical College Hospital, Jamshoro / Hyderabad from July 1992 to June 1994. The median age for the series was 60 years. Sex incidence male to female ratio 14:1.23 patients [76.7%] had bleeding per rectum. Twenty [66.6%/ had altered bowel habits. Ten cases [33.3%] had pain in the abdomen. Location of the tumour in the lower one third 18 cases [60%], middle one third 26.7%, upper one third 4 cases [13.3%]. Dukes staging were stage A 0, stage B 7 [23.3%], stage C 13 [43.3%], stage D 10 [33.3%]. Operations done were colostomy 23 [76.7%], abdomino perineal resection 6 [20%]. Anterior resection 1 [3.3%]. Resectability rate 26.7%, operative mortality 3.3%, no recurrence complications, retention of urine 16.7%, urinary tract infection 33.3%, perineal obscess 13.3%, haemorrhage 6.7%, stomal complications 16.7%, abdominal wound infection 13.3%