Thrombocytopenia; frequency and degree in patients with falciparum malaria

Malaria is usually associated with reduction in blood cell counts and mild to moderate thrombocytopenia is a common feature of falciparum infection. This study has been conducted to find out frequency and degree of thrombocytopenia in patients suffering from falciparum malaria at a tertiary care hospital of Abbottabad. It was a descriptive case-control study being carried out at Ayub teaching hospital and Northern institute of Medical Sciences [NIMS] Abbottabad over a period of ten months. All patients with acute febrile illness without localizing signs were considered for study. A total 250 patients having falciparum malaria diagnosed by peripheral blood film examination have been studied. Complete blood counts were performed by Automated Beckman Coulter Analyzer. Blood films were examined by clinical pathologist for plasmodium falciparum via light microscopy using oil-immersion lens. Out of 250 patients, 155 [62%] were females and 95[38%] males with M: F ratio of 1:1.5. Mean age was 36 +/- 1.2 years [range 17-58 years]. Out of 250, 175[70%] had thrombocytopenia [p<0.05] while 75 [30%] had normal platelet counts. Thus mild, moderate and severe thrombocytopenia had been observed in 121[48.4%], 41[16.4%] and 13[5.2%] respectively [p<0.05]. Fever appeared to be most common symptom observed in all patients [100%] followed by vomiting and nausea [88%]. Anemia was the commonest sign present [80%] during our study. We discovered high frequency of mild thrombocytopenia in falciparum malaria. Therefore, thrombocytopenia can be supportive in diagnosis of plasmodium falciparum infection

three-year audit of rigid oesophagoscopy at lady reading hospital Peshawar

The number of oesophagoscopies performed annually provides an indication of the extent of oesophageal disorders in any particular setting. The present study aimed to provide such data for rigid oesophagoscopy at the only referral centre for this procedure in Peshawar. An audit of all available records of patients undergoing rigid oesophagoscopies from January 2002 to December 2004, at the Lady Reading Hospital Peshawar was performed. A total of 200 cases of rigid oesophagoscopies were performed during this three-year period of study. The ages of patients ranged from 1 to 90 years, with a two fold male preponderance. The main indication was dysphagia with major causes being oesophageal carcinoma [115, 57.5%], reflux oesophagitis [56, 28%], strictures of various aetiologies [19, 9.5%] and foreign bodies [10, 5%]. Successful dilatation was possible in 70% of cases; the morbidity rate was 4.5% due to perforation observed in 9 cases. The mortality rate was 1.5% due to septicemia in 3 cases. A high rate of rigid oesophagoscopies was observed indicating an increased frequency of oesophageal disorders in this setting. The morbidity and mortality rates observed are within acceptable ranges for this procedure

experience of 108 cases of esophagectomy using left thoracolaparotomy and cervical anastomosis with feeding jejunostomy, without gastric drainage procedure

Objective: To study efficacy and safety of esophagectomy using left thoracolaparotomy and left neck anastomosis with feeding jejunostomy, but no gastric drainage procedure

Design: An observational descriptive study

Place and Duration: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from June 2002 to September 2004

Subjects and Methods: Computerized clinical data of 108 surgically treated patients during twenty eight months was retrospectively analyzed. Detailed scrutiny of record was carried out to determine the suitability and safety of the surgical procedure and surgical outcome

Results: A total of 108 patients underwent esophagectomy through left thoracolaparotomy and left neck incision. Male: Female was 72: 36, age range was 18 - 72 years with a mean age of 42.3 years. The predominant clinical presentation was dysphagia. Tumor level was upper third of thoracic esophagus in 3 [2.7%], middle third in 48 [44.4%] and lower third in 57 [52.7%] patients. Tumor histology was squamous cell carcinoma in 72 [66.6%] and adenocarcinoma in 36 [33.3%] patients. The mean operative time was 155 [25 +/- ] minutes. Postoperative morbidity was 19.4% [21/108]. The complications were anastomotic leak in 7[6.5%], Hoarseness in 6[5.5%], aspiration in 3[2.7%]; reopening in 1[0.9%] and stricture in 4[3.7%] patients. The overall mortality was 8.3% [9/108]. Deaths were due to anastomotic leak in 3[2.7%] tracheal injury in 2[1.85%], respiratory failure in 2[1.85%] and pulmonary embolism in 2[1.85%] patients. 28 patients were lost to follow-up while incisional hernia was seen in 1, hoarseness in 3 and stricture in 3 patients over a last one month to 2 years follow-up. Recurrence occurred in 3/108 [2.77%]; one developed malignant ascities, after 4 months, one developed nodule in hypopharynx after 18 months, and one developed a subcutaneous nodule on the back after 14 months

Conclusion: Left thoracolaparotomy and cervical anastomosis is a safe approach for carcinoma of the esophagus. A 30 day mortality of 8.3% in a large series of 108 oesophagectomies with 2.7% recurrence and 19.4% morbidity speak volumes for the technique. Omitting a gastric drainage procedure does not adversely effect the outcome, while routine placement of a jejunostomy feeding catheter is a safe and cost effective mode of nutrition. Neck anastomosis gives a generous tumor free margin, a s a 11 except one resection margin was free o f tumor. T his i s further consolidated by only 3 cases of recurrence out of 80, with 28 being lost to follow up

Pneumonectomy for benign lung disease

Objective: This study was done to define morbidity and mortality of elective pneumonectomy for benign lung disease, as well as to recommend safety measures

Design: An observational descriptive study

Place and Duration of study: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from June 2002 to September 2004

Material and Methods: Thirty six patients received elective pneumonectomy. Male : Female 21 : 15. Age range was 4 months to 72 years. Past recurrent or new pulmonary tuberculosis was seen in 33/36 patients. Thirty one patients had chronic hemoptysis, while 6 had massive hemoptysis while thirty two had end stage destroyed lung. Left Right ratio was 24: 12. Double lumen endotracheal tube was used in 32 cases. Standard transpleural pneumonectomy was done in all cases with slight head down tilt of the table. Bronchial closure was done in 2 layers with interrupted Prolene 2/0 and 4/0. Single unclamped chest drain was put in all cases and removed after 24 hours

Results: Thirty day mortality was 1/36 [2.7%]. Morbidity included post pneumonectomy BPF 2, post pneumonectomy empyema 3 and wound infection 1. Both bronchopleural fistula and post pneumonectomy empyema were treated by tube thoracostomy initially, while 2 patients subsequently required additional thoracostoma and later space closure. Of these 1 went on to have thoracoplasty

Conclusion: Pneumonectomy proved effective therapy for end stage destroyed lungs with active / recurrent hemoptysis, but post pneumonectomy empyema and BPF are serious complications. Early clamping of the bronchus and avoiding bearing of bronchus reduce morbidity. There is no need to clamp the chest drain, which should be removed after 24 hours