Laparostomy: three year experience in a tertiary-care unit

Laparostomy is a temporary measure to avoid abdominal compartment syndrome as well as allow repeated and ready access to abdomen for lavage. This study was conducted to identify the indications and analyze the outcome of laparostomy in a tertiary care surgical ward. This prospective study was conducted on laparostomy cases between March 2008 and February 2011. Data was analyzed for the indication, clinical course and final outcome. Results were expressed as frequency-percentage, means, procedural morbidity and overall mortality. A total of 16 laparostomies were performed during the study period. All 16 patients were operated in emergency. Burst abdomen with impending intra-abdominal hypertension was the most common indication followed by "grossly edematous bowel" which made primary closure impossible. A delayed deep tension closure was possible only in eight patients. Four patients died in the postoperative period. Persistent wound sepsis was the most common morbidity. Laparostomy is often necessitated by the desperate situations encountered in emergency surgery

Typhoid and non-typhoid ileal perforation: surgical experience of 50 cases

The objective of the study was, to find out the frequency of typhoid and non typhoid ileal perforation, to observe the association of various epidemiological factors in causation of disease and to note surgical, clinical, and laboratory findings along with mortality. A comparative descriptive study. The study was conducted in the department of surgery Civil Hospital Karachi from June 1997 to August 1998. fifty consecutive patients of non-traumatic ileal perforation managed surgically were observed by making two groups of typhoid and non typhoid ileal perforation. Out of 50 [n=50] 32 [Group - A] patients [26 male and 6 female] had typhoid while 18 [Group - B] patients [15 male and 3 female] had non-typhoid ileal perforation. There were 41 [82%] male and 09 [18%] female. In-group A age range was 16-50 years and a mean of +/- SD of 25 +/- 10 while in group B age range was 12- 60 years and a mean of +/- SD of 26 +/- 11.65. In group A 90.6% while in group B 100% patients had a single perforation. Wound infection was the most common complication. Mortality was 6.25% and 5.5% in group A and B respectively. There was no significant association [P<0.05] of gender, seasonal and living conditions. Surgical cum Epidemiological findings point out to the need of distinguish between different types of non traumatic ileal perforation, and having check on the related causative factors leading to their occurrences

Incidence of refractive error among adult population: a Hospital base study / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To assess the incidence of refractive error among adult population: a Hospital base study.·METHODS: This Hospital based study was conducted between June 2008 to November 2008 at tertiary referral center, Liaquat University Eye Hospital, Hyderabad. All subjects underwent a complete ophthalmic examination. The best corrected visual acuity(BCVA) was ecorded. Refraction data are based on subjective refraction. Only the right eye of each subject was considered. Hypermetropia was defined as a spherical equivalent greater than +0.5 diopter sphere (DS). Emmetropia was defined as a spherical equivalent between -0.50 and +0.50DS, myopia was defined as a spherical equivalent worse than -0.50DS and a spherical equivalent or worse than -5.00 DS was classified as a high myopia. Astigmatism correction was prescribed in minus cylinder format, and astigmatism was defined as cylinder error worse than -0.50 diopter cylinder (DC) in any axis. ·RESULTS: Eight thousand and four hundred patients were attended the out patients department with age range of 20-60 years. The proportion of men and women was 61∶ 39. Both the rural and urban population were treated. Sixty seven percents of patients has completed their higher secondary education.Of the total 8 400 patients 2 719(32 37%) had BCVA 20/40 or better and remaining 5 681(67.63%) had BCVA poor than 20/40 due to different anterior and posterior segment eye pathologies, and were excluded from study. Of the 2 719 patients 1 065(39.17%) were phakic in right eye and making the 12.68% of total (8 400) examined patients, and remaining 1 654(60.83%) were pseudophakic. The result were analyzed for only 12 68(1 065 phakic ametropic patients) percent of total treated patients in last 6 months. There were 590(55.40% of phakic patients) men and 475(44. 60%) women.Hypermetropia was found in 300 patients (28.20% of phakic ametropic). Six hundred and ninety (64.80% of phakic ametropic) patients had myopia. The incidence of myopia increased significantly with age. High myopes constituted 7%(75) of the study population. Four hundred and five (38.03% of phakic) patients had astigmatism worse than 0.5D cylinder. There were 195(48.15%) men and 210(51.85%) women. ·CONCLUSION: Refractive error is a significant public health problem in our population that may be impact on visual function and activities of daily life. Optimal visual function may be compromised with uncorrected or under-corrected refractive errors.

Management of the anal fissure: a comparison between lateral internal sphincterotomy with manual dilatation of anus

Design: It was a comparative study of randomly selected sample of 50 patients

Purpose: To compare the results of lateral internal sphincterotomy with manual dilatation of anus under general anaesthesia in the management of fissure in ano in terms of [Relief of symptoms, Post operative complications]

Place and Duration of study: Patients presented to Surgical unit, Bahawal Victoria Hospital, Bahawalpur from 15-02-2002 to 14-02-2004

Material and methods: This was a prospective type of comparative study. The patients of fissure in ano were randomly divided into two groups. Group A patients were treated by lateral sphincterotomy and Group B patients were treated by manual dilatation of anus under anesthesia. Follow up protocol was also maintained. Patients were examined and evaluated according to the comparison criteria which were [Relief of symptoms, Complications developed, Recurrence and Healing of fissure]

Result: Out of these 50 patients, 32 were male and were female. In Group-A, 92% of patients were completely cured, 4% of patients developed retention of urine while 4% of patients developed post-operative bleeding. The success rate was 92%. In Group-B, success rate was 72% out of remaining 8% developed incontinence of flatus, 8% developed incontinence of faeces, 4% developed retention of urine while haematoma was observed in 4% of cases.The data was analysed with [SPSS] on computer, Standard Error of Difference Between Two Proportions was applied. Chi square test was applied and P value found to be 0.04 which is less than 0.05 [Statistically insignificant]

Conclusion: On the basis of this study, it was concluded that the results of Lateral Internal Sphincterotomy in the management of anal fissure is safer and more effective than manual dilatation of anus under anaesthesia

Efficacy of various antiemetics in the control of nausea and vomiting induced by cancer chemotherapy

To assess the potency and efficacy of various antiemetic agents in the prevention of nausea and vomiting observed in the patients taking various cytotoxic chemotherapy protocols. Prospective comparative study. Department of Surgery, Unit 2 BVH Bahawalpur. Hundred patients with various malignancies taking combined cytotoxic chemotherapy were evaluated for the efficacy and potency of three antiemetic agents, Metoclopramide, Ondansetron and Tropisetron with and without corticosteroids. Sixty-two patients were males and 38 females, aged ranging from 3 to 65 years. Patients received each antiemetic agent during one or more course of chemotherapy for a total of 600 courses administered intravenously exclusively. Each agent was administered as a single intravenous dose slowly before the start of chemotherapy on day 1 or by mouth on subsequent days [median treatment duration: 5 days]. The patients receiving cancer chemotherapy had a 40%, 65% and 70% complete response rate and 10%, 20% and 24% partial response rate respectively for metoclopramide, ondansetron and tropisetron during the first 24 hours period of the first course. We observed drowsiness [six cases], extrapyramidal signs [seven cases] and headache [seventeen cases] of metoclopramide while with ondansetron and tropisetron diarrhea was seen in 5 and 3 cases and headache in 7 and 5 cases respectively as side effects. 5-HT3 receptor antagonists are safe, effective, easy to use, has no serious side effects and can be recommended for all age patients. The efficacy of all antiemetics may be enhanced by the addition of corticosteroids, with a more superior edge in 5-HT3 receptors antagonists especially in patients receiving highly emetogenic cytotoxic chemotherapy

Split thickness skin grafting; change of 1[st] dressing of donor area

Objectives: 1] To compare the result of early [7[th] day] with late [14[th]] dressing. 2] To establish protocol for the change of 1[st] dressing of donor area after STSG Design: A comparative [case control] study. Setting: Surgical unit B V Hospital Bahawalpur. Period: From 2001 to 2003

Material and Methods: All the patients who under went STSG due to any reason were included in the study. Patients were divided into two randomized groups. In one group dressing of donor area was changed at 7[th] postoperative day while in other group, 1[st] dressing was changed on 14[th] postoperative day. The two groups were compared in speed of healing; postoperative pain, cosmetic result and patients satisfaction

Results: Total 31 patients [13 in group A and 18 in group -B] were included in study, 22 were male and 9 were female. Ages between 4 to 65 years with an average of 32.2 years. Diseases causing morbidity were burn [7 patients], Diabetes [5 patients] infection [12 patients], Cutaneous malignancies and others miscellaneous causes [7 patients]. Postoperative result have shown that in group- B [case] ] there was a maximum healing [16 out of 18 patients] as compared to group -A [control]. [5 out of 13 patients]. In group B only in 1 patient healing was delayed beyond 2 weeks and in one patient there was some degree of infection. In case of group A in 6 out of 13 patients healing was delayed beyond two week and in 2 patients there was infection of the wound. Many patients were not happy with cosmetic results as the donor area showed varying degree of hyperemia, scaring and discoloration, yet results were found to be more satisfactory and acceptable in group -B. Patient's satisfaction was good in case of group -B [13 out of 18 patients] as compared to group -A [7 out of 13 patients ]. Postoperative pain was a common problem in both groups

Conclusions: Healing is improved, speedy and well tolerated in case the 1[st] dressing is changed on 14[th] day