Shouldice versus lichtenstein repair

To compare the results of tissue based Shouldice repair with the Lichtenstein tension free repair of inguinal hernia. A prospective randomized controlled trial. From Jan 2004 to Dec 2006. Surgical Unit-II, Allama lqbal Medical College /Jinnah Hospital Lahore, Pakistan. A total of 156 patients were included in this study were equally divided into two groups. The mean age was 45 years. After a follow up of upto 2 years there was significant difference in the recurrence rate. It was 5% in the Shouldice group and 1.28% in the Lichtenstein group. Similarly chronic pain was also much higher i.e. 5% in the Shouldice group compared to 1.28% in Lichtenstein Group. The rate of hematoma and seroma formation was the same [1.28%] in both groups, however infection was seen slightly more in Lichtenstein repair [3.84%] as compared to Shouldice repair [2.56%]. Tension free Lichtenstein technique was found to be superior to the tissue based Shouldice repair with respect to post operative complications and recurrence

Ultrasound as a reliable guidance system for percutaneous nephrostomy

To determine the effectiveness and safety of ultrasound as a reliable guidance system for percutaneous nephrostomy [PCN]. Quasi-experimental. Jinnah Postgraduate Medical Center, Karachi, Pakistan, from January 1997 to July 2005. One hundred and fifty-three PCN were performed in 140 patients, referred from the Department of Urology and Transplantation, JPMC. Out of 140 patients, 137 had obstructive uropathy [>1 cm dilated pelvicalyceal system] of different etiologies. Three patients with ureteral rupture [non dilated pelvicalyceal system] underwent PCN for urinary diversion in the surgical ICU. The technique involved a pre procedural scan, initial renal puncture, placement of a guide wire, tract dilation and placement of 8-12 F Nephrostomy tube, entirely under ultrasound guidance. The machine used was "Just vision" or "Eccocee" with 3.5 MHz variable frequency convex transducer. Effectiveness in terms of successful tube placement and safety in terms of complications were observed. Out of 153 patients there were 78 males and 62 females. The minimum age of patient was 13 years while maximum age was 68 years, all [100%] patients had successful placement of PCN. Minor complications like transient gross hematuria and small perinephric collection occurred in 13 cases [8.5%] but was dealt with effectively by conservative measures. No major complications like hemorrhage, sepsis or periorgan damage were encountered in any of the patients. Ultrasound was found to be a rapid, effective, radiation-free, portable and safe imaging modality with minimum rate of complications that could be used as a reliable guidance system for critical interventions like percutaneous nephrostomies without using fluoroscopic units

Ultrasound guided percutaneous drainage of pancreatic pseudocysts using P.O. catheter

Objective: The purpose of the study is to report the drainage of pancreatic pseudocysts by percutaneous insertion of P.O. catheter under US guidance

Patients and Methods: Between January 1999 and December 2003, 44 patients [28 male, 16 female] with abdominal fluid collection from complicated acute pancreatitis underwent percutaneous ultrasound guided drainage using adult [12 F] or pediatric [10 F] peritoneal drainage catheter

Results: Simple cysts found in 07 patients, haemorrhagic in 20 and infected in 17 patients. Etiology varied from trauma in 09 patients, gallstone in 19 patients, post ERCP 05 patients, biliary ascariasis in 03 and alcohol consumption in 01 patient to idiopathic 07 patients. The tube was kept for drainage from 2 weeks to 11 weeks. The success rate was 84% whereas 12% patients did not improve and required open drainage and lavage. No major complications occurred

Conclusion: The study shows that complicated peripancreatic fluid collections can be safely and effectively treated in most patients with percutaneous P.D. catheter insertion under real time US guidance