Frequency of difficult cholecystectomy in patients with thick walled gall bladder

Background: Laparoscopic cholecystectomy is the procedure of choice for cholecystitis. There are variable rates of conversion of laparoscopic cholecystectomy to open cholecystectomy. Various studies have highlighted gall bladder wall thickness and age as independent risk factors for conversion from laparoscopic to open procedure. This study was done to determine the frequency of conversion of laparoscopic cholecystectomy to open cholecystectomy in patients undergoing laparoscopic cholecystectomy with a gall bladder wall thickness of more than 3mm as determined on pre operative ultrasound

Objective: To find frequency of conversion to open procedure in patients undergoing laparoscopic cholecystectomy with a gall bladder wall thickness of more than 3mm as determined on pre operative Ultrasound

Methods: This Case series was conducted at the Surgical Unit IV Civil Hospital Karachi, Pakistan from 15th July 2012 to 15th January 2013. A total of 129 patients were included in the study with gall bladder wall thickness of more than 3mm on Ultrasound. Patients were stratified according to age, sex, gall bladder wall thickness, frequency of difficult cholecystectomy and duration of disease

Results: A total of 129 patients were included in the study. Female to male ratio is 5.7:1. The mean age of patients was 43.33 +/- 11.5 years. The average gall bladder wall thickness was 4.07 +/- 0.63 mm and duration of disease was 4.53 +/- 4.67 years. Regarding preoperative findings, bleeding during separation from liver bed was the commonest finding in general i.e. 35.7% followed by local adhesions 33.3% and perforation of gall bladder was observed in 7.8% cases. All [n=13] patients who had conversion to an open procedure had wall thickness between 4.1 to 6 mm. Similarly rate of conversion was found to be in higher in patients with symptoms for more than 5 years [i.e. 9 out of 24]

Conclusion: Ultrasound for gall bladder wall thickness is a good predictor for difficult cholecystectomy. It should be used as anticipative measure for difficult cases and patient should be properly counseled regarding chances of conversion

Thawed plasma: maintaining efficacy while minimizing wastage

According to regulatory guidelines, Fresh Frozen Plasma expires within 24 hours of thawing. Therefore, if transfusions are delayed or cancelled, FFPs are often wasted. The coagulation factor activity of thawed plasma was extensively researched and it was determined that most of the factor activity maintained its efficacy for four days after thawing making it usable with equivalent clinical results. Although derived from FFP, the composition of this product differs slightly and so, the AABB introduced this product as a separate entity called Thawed Plasma. In the US, many blood banks have been using Thawed Plasma interchangeably with FFPs. This not only increases the inventory of plasma products but also eliminates thawing time, providing faster patient care. There are still some concerns regarding transfusing neonates and liver failure patients, but for the majority of surgical patients or those with elevated INRs, Thawed Plasma is an acceptable alternate to FFP. This manuscript reviews attributes and benefits of thawed plasma and its approval by various recognized authorities

complex - regional pain syndrome after fractures of distal radius

Objectives: The present study aims to determine frequency of Complex regional pain syndrome [CRPS] after distal radius fractures on the basis of clinical examination findings and classify into stages and to find out association of CPRS with age, genders, and risk factors. Study Design: Prospective cross sectional study Place and Duration of Study: This research work was conducted at the Department of Orthopaedics, Creek General Hospital Korangi Karachi, Pakistan from January 2013 to April 2014. Materials and Methods: This is a prospective cross sectional study of 150 cases. Follow up of patients is undertaken in out- patient department for a minimum 4 months period following injury. The percentage of patients with CRPS was identified according to IASP Diagnostic Criteria based on history and physical eamination.'.'. Patients were studied prospectively to ascertain the incidence, natural history and the degree of morbidity induced by CRPS. Results: Mean* SD age was 45.6f 14.2 years [Range = 18 - 75 years]. There were 88 [58.7%] males and 62 [41.3%] females with Male: Female = 1: 0.7. CPRS was found in 20 [13.3%] cases. Out of 20 CRPS patients 12 [60%] were female, out of 20 CRPS patients 12 [60%] had age 40 - 59 years and 8 [40%] had age >59 years. Out of 20 CRPS patients 14 [70%] were diagnosed in stage 1. Conclusion: The incidence of CRPS after distal radius fracture in this study is 13.3%.Proportion of CRPS was high in females and in old patients. Most of the patients of CRPS were diagnosed in stage 1. Diabetes mellitus, hypertension, stroke, carpal tunnel syndrome and myocardial infarction were the risk factors found in patients diagnosed with CRPS. CRPS is an under diagnosed entity. More work needs to be done on CRPS as many areas of research remains

Lower risk of thrombosis in blood group O patients: are low clotting factor levels the reason?

Background: The ABO Blood group system has been evaluated many a times for increased risk of vascular accidents and heart diseases. This study aims to prove that the reason behind the decreased risk of thrombosis in O blood group population could be the decreased levels of clotting factors in its plasma compared to other blood groups

Objective: To assess the levels of clotting factors VII, VIII, IX and X in all blood groups to determine whether blood group O has the lowest levels of all clotting factors in its plasma

Methods: This is a Descriptive Cross sectional study, conducted at Dr. Ziauddin Hospital Karachi and Dow University of Health Sciences over a period of six months. The study involves 16 plasma units divided into four of each blood group. On the day of testing plasma was thawed and assays of factor VII, VIII, IX and X were performed on all blood groups and results noted

Results: Levels of Factor VIII, IX and X were found to be highest in blood group AB and lowest in blood group O. Factor VII levels varied from others

Conclusion: Our results showed that factor VII levels vary in different blood groups, may be due to its short half-life. Thus we could not establish a link between ABO blood groups and clotting factor levels