Diagnostic yield of D-dimer in pulmonary embolism

To determine the diagnostic yield of D-dimer in combination with multi-detector computed tomography [MDCT] in patients with clinical symptoms and signs of acute pulmonary embolism. Cross sectional observational study. This study was carried out in Radiology Department Rashid Hospital Dubai UAE, from October 2011 to September 2012. In patients with clinical symptoms and signs of acute pulmonary embolism, D-dimer and MDCT were performed. Pulmonary angiography was performed to compare the results. For descriptive purpose the patients were divided into four groups. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value were calculated. There were total of 151 patients of whom 97 [64.2%] were males and 54 [35.8%] females. The mean age of the patients was 47.26 +/- 16.16 year. Shortness of breath was noted in 104 [68.9%, p = 0.000], chest pain in 88 [58.3%, p = 0.042] and cyanosis in 57 [37.7%, p= 0.061] patients. The D-dimer test was positive in 80 [53.0%] patients while CT angiogram in 56 [37.1%] patients. In 52 patients both D-dimer and MDCT angiogram were positive, while 65 patients had normal D-dimer and CT angiogram. The sensitivity of D-dimer in combination with CT angiogram was 92.85%, specificity 68.42%, false positive rate 31.57%, false negative rate 7.14%, positive predictive value 63.41%, negative predictive value 94.20% and accuracy 77.48%. D-dimer is an easy, non-invasive, safe, efficient and cost effective method of diagnosis in clinically suspected cases of pulmonary embolism

functional ectopic vaginal anus: a rare clinical entity

A case of functional ectopic vaginal anus is presented in a 20 years old girl. Patient complained of passage of stool through her vagina. She was continent and had no complaint of constipation. Her examination revealed imperforated anus with functional ectopic vaginal anus. Her surgery was performed in two stages. In first stage, anoplasty was performed at midpoint between the vulval and anal opening. The posterior vaginal wall was repaired in two layers and protective loop colostomy was made. In the second stage, after a period of 3 months loop colostomy was closed. Patient's recovery was smooth, she is not constipated and continent with Wexner score of 3. She was advised pelvic floor rehabilitation exercises. She improved within a month with Wexner score of zero

Missed intrauterine contraceptive device presenting as urinary bladder stone

Presence of foreign body in urinary bladder is an uncommon condition. It often causes difficulty in diagnosis. A multiparous woman with history of intrauterine contraceptive device [copper T loop] placed two year back presented with urinary frequency, urgency, dysuria and suprapubic pain on frequent occasions. Investigation revealed a urinary bladder calculus encrusted upon displaced copper T loop. Cutaneous cystolithotomy was performed along with tubal ligation. Postoperative recovery was uneventful.

Fibrolamellar hepatocellular carcinoma- a rare clinical variant

Fibrolamellar type is a rare variant of hepatocellular carcinoma [FLHCC]. A 20 year old boy presented with pain and mass in the epigastric region for the last six months. Early diagnosis and confinement of the lesion to a lobe made it possible to perform complete resection of tumour along with subtotal gastrectomy. Patient recovered well and was sent to oncologist for further treatment

Abdominal tuberculosis: a surgical perspective

To document the clinical presentation, operative findings, surgical procedures and complications of abdominal tuberculosis. Retrospective study. This study was conducted in Surgical Unit II of Bolan Medical Complex Hospital, Quetta during August 2001 to August 2006. This study included patients, who presented with clinical features of intestinal obstruction. They were either known cases of abdominal tuberculosis or diagnosed at the time of laparotomy. Tissue biopsy specimen was taken from all the cases for histopathological examination. A total of 7983 patients were admitted during the last 5 years. Among them 294 were admitted with acute or chronic intestinal obstruction. All of them were operated. Two hundred were suffering from abdominal tuberculosis. Majority of them were in their 4th decade of life. The male to female ratio was1:1.63. The most common clinical presentation was the weight loss [88%], abdominal distension [73%] and abdominal pain [46%]. Peroperative findings revealed ileal perforation in 44.0%, multiple adhesions in 26.5% and ileocaecal mass in 14.0%. Resection of gut and primary anastomosis was performed in 38.0% and adhesiolysis in 22.0%. The major cause of morbidity was wound infection [17.0%], faecal fistula [9.5%] and burst abdomen [6.5%]. The mortality was 12.0%. Abdominal tuberculosis is one of the major causes of acute abdomen in developing countries. It affects the people of working age group of the society. It imparts a great deal of morbidity as well as economic loss

comparative study of opiod and NSAIDs as post operative analgesia

To compare the analgesic effect of opiod and non steroidal anti inflammatory drugs [NSAIDS] during the first 24 hours after surgery. This study was conducted in Surgical Unit II of Bolan Medical Complex, Hospital, Quetta during the month of August 2006. A total of 107 postoperative patients equally matched at age, sex and type of surgery were assessed for 24 hours after surgery for pain and side effects of drugs. Patients of trauma and malignancy were excluded. Patients were divided into two groups. In Group A, 54 patients received inj. tramadol 100 mg intramuscularly [IM] at 8 hourly interval while the group B 53 patients received inj diclofenac sodium 75mg IM 8 hourly. Pain relief score was graded as excellent, very good, good and poor. In this study of 107 patients the age ranged from 12- 70 years, with mean age in group A of 39.65 year and in group B 42.35 year. The male to female ratio varied in different surgical groups like abdominal surgery 1:2.3 anorectal 6.5:1, inguinoscrotal 13:1, urological 1:5, miscellaneous 1:5. Postoperative pain relief assessment during first 24 hours after surgery in group A was graded as: 21 patients [38.88%] excellent and 18 patients [33.33%] very good, while in group B, 14 patients [26.41%] had excellent and 27patients [50.94%] very good pain relief. In group A only 5 patients had mild headache and nausea, while in group B no side effects were observed. When the results of excellent pain scale were analyzed statistically it was found that accuracy to control the early postoperative pain with opiod was 56.07%, while with NSAIDs 43.91%

Comparison of unfractionated heparin vs low molecular weight heparin in the treatment of acute deep vein thrombosis

To compare the results of unfractionated heparin [UFH] with low molecular weight heparin in the treatment of acute deep vein thrombosis of lower limb. Randomized control trial. Bolan Medical Complex Hospital, Quetta from January 2002 to July 2003. Thirty patients who presented with acute deep vein thrombosis of lower limb, confirmed by either Doppler ultrasonography or venography, were selected for the study. Patients were divided randomly into two groups for treatment. Group 1 was started with unfractionated heparin while group 2 with low molecular weight heparin. Comparison of two treatments to determine the efficacy was done by certain criteria like pain improvement, reduction in swelling, alteration in bleeding profile, complications of therapy, recurrence, morbidity and mortality. The age of the patients ranged from 16-82 years. There were 15 females [50.00%] and 15 males [50.00%]. Pain and swelling were present in all patients [100%], while temperature and superficial vein dilation in 43.3% and 30% respectively. The distribution of DVT in left lower limb was in 13 patients [43.33%], right lower limb involvement in 12 patients [40.00%] and both limbs involvement in 5 patients [16.67%]. In group 1 improvement in pain occurred after 4th day in 13 patients, while in group 2 before 4th day in 8 patients [p-value=0.068]. Improvement in swelling was observed after 6th day in 11 patients [group 1], while before 6th day in 8 patients [group 2] [p-value=0.171]. Bleeding time was prolonged in 5 patients in group1and statistically found significant [p-value=0.014], while in group 2 it was normal. Thromboembolism in 3 patients and major bleeding was observed in 2 patients in group 1, while in group 2 it was normal. Recurrence was reported in 2 patients in group 1 and 1 patient in group 2 [p-value 0.0815]. The hospital stay was more than 10 days in group1 [12 patients], and less than 10 days in group 2 [13 patients]. It was found statistically significant [p-value=0.001]. Three patients died in group 1, while no mortality was observed in group 2. Treatment with low melecular weight heparin [LMWH] has good patient compliance and is easy to administer. LMWH has an advantage over UFH due to its normal bleeding profile and significantly less hospital stay

Diagnostic yield of color doppler ultrasonography in deep vein thrombosis

To see the diagnostic yield of color Doppler ultrasonography in patients who presented with clinical symptoms and signs of acute deep vein thrombosis of lower limb. Descriptive study. The study was carried out in Bolan Medical Complex Hospital, Quetta from January 2002 to December 2002. Twenty five patients, who presented with clinical symptoms and signs of acute deep venous thrombosis of lower limb, were selected. In all patients color Doppler ultrasound and venography was performed to compare the results. The age of the patients ranged from 16-82 +/- 20.33 years. The mean was 49.16, median 50.00 and mode 60.00 There were 15 females [60.00%] and 10 males [40.00%]. Left lower limb involvement was seen in 12 patients [48.00% +/- 0.51], right lower limb involvement in 10 patients [40.00% +/- 0.50] and both limbs involvement in 3.0 patients [12.00% +/- 0.33]. Color Doppler ultrasound was positive in 16 patients [64.00% +/- 0.48] while venography was positive in 21 patients [84.00% +/- 0.37%]. Doppler ultrasonography and venography showed that 11 patients [52.38%] had distal DVT, while 10 patients [47.62%] had distal as well as proximal DVT. Ten patients [100.00%] of proximal as well as distal DVT were diagnosed by CDU and later confirmed by venography. Eleven patients [100.00%] of distal DVT only in whom 6 patients [54.54%] were diagnosed by CDU, while 5 patients [45.46%] had inconclusive findings, which were confirmed by venography. Doppler ultrasonography compared venography showed sensitivity 76.1%, specificity 100%, positive predictive value 100%, negative predictive value 44.45% and accuracy 80.00%. Color Doppler ultrasonography is a non-invasive, safe, efficient and cost-effective method in diagnosing acute deep venous thrombosis of lower limb but still it has not 100% accuracy. It is better for diagnosing proximal DVT than distal DVT. 7

Accessary thyriod nodule in sub-mandibular region

A case of an accessory thyroid nodule with a diagnosis of focal lymphocytic thyroiditis, in 23 years old lady, on histopathological examination, is presented. Patient had a single swelling in the left submandibular region without any abnormality. Postoperative thyroid scan showed thyroid gland in its normal anatomical location with suppressed activity and thyroid profile revealed subclinical hypothyroidism

Peptic duodenal perforation-an audit

This study was carried out from November 1996 to August 1998 in the Surgery Department of Sandeman Provincial Teaching Hospital, Quetta, on a total of 40 patients hospitalized with peptic duodenal perforation. The major- of the patients [92.5%] was below 50 years of age with peak incidence in the third decade of life [32.5%]. The mean standard deviation of patients' age was 31.4 ' 13.3 years and male to female ratio was 12.3:1. The incidence among males was 9 per 1000 patients and in female 1 per 1000 patients. The overall incidence was 7 per 1000 patients. The majority of the patients [82.5%] came within 48 hours. The median duration of perforation was 40 hours. In all the patients there was a single perforation at the first part of duodenum on anterior surface. The median size was 4.5 mm. Simple closure with viable omental patch repair was performed in all the cases. Patients with longer duration of perforation had increase morbidity to wound and respiratory tract infections [P<0.001 by Chi sq test]. Most of the patient remain admitted for less than 10 days. Their median hospital stay was 14.5 days with minimum stay of 6 days and maximum stay of 32 days. The overall mortality was [7.5%] attributed to old age, leakage from repair site and associated medical illnesses. The duration of perforation had no effect on mortality in this study