Haemoperitoneum secondary to spontaneous rupture of liver tumour

Hepatocellular carcinoma (HCC) is the most common primary tumour of the liver. Cholangiohepatocellular carcinoma (CHC) is less common and is a variant of HCC. There are many similarities with HCC with the exception that CHC tend to be more aggressive. We report a case of a 50-year-old man who was diagnosed with CHC and suddenly deteriorated secondary to hepatic tumour rupture. Despite aggressive supportive care, his condition rapidly deteriorated and died. Autopsy showed ruptured CHC.

Comparative study of management of common bile duct stone, our experience of 20 patients at sir Ganga Ram hospital Lahore

To compare different methods of management of CBD stones at Sir Ganga Ram Hospital Lahore i.e ERCP with pappilotomy, Sphinterotomy or removal through Dormia's Basket and Open Cholecystectomy with choledochotomy. It was observational comparative Study. The adult patients having CBD stones. One years i.e. from 15[th] June 2008 to 15[th] June 2009. The mode of management of these patients for common bile duct stones was absorved. The out come and complications of both techniques were compared. Total 20 patients were included in the study. Out of them 12 were managed by open cholecystectomy and choledochotomy and the remaing 8 were treated by doing endoscopic retrograde cholangiopancreaticogram [ERCP]. The out come of both techniques were than compared. In our Hospital the majority of the patients of CBD stones are being managed by open technique i.e. open cholecystectomy and choledochotomy along with T-tube insertion, which is contrary to the approach of developed countries i.e. endoscopic and laproscopic approach

Obesity related compications in 100 obese subjects and their age matched controls

To note obesity related complications in subjects of age range 50-59 years. A case control study was conducted at Medical Unit of District Headquarters Hospital, Rawalpindi for 6 months. Hundred obese subjects in the age range 50-59 years and their age matched non-obese 100 controls were included consecutively from general population. Obese subjects had body mass index [BMI] >30Kg/m2. Controls had BMI of 18.5-22.9Kg/m2 and normal waist hip ratio. Obesity related complications i.e., hypertension, diabetes mellitus, ischemic heart disease, stroke, hyperlipidemia, gall stones, varicose veins, psychological problems, sleep related problems, and degenerative arthritis, were sought in all subjects. Waist hip ratio was noted as measure of central distribution of body fat in obese subjects. Of the 200 subjects, 59% [n=118] were female and 41% [n=82] male. Of the obese subjects 74% and 44% of non-obese controls were female. Mean age of obese subjects and their controls was 54.4'3.22 and 54.57'3.54 years respectively. Central obesity was noted in 84% of obese subjects. Hyperlipidemia [87%], hypertension [71%], diabetes mellitus [65%], gallstones [57%], ischaemic heart disease [49%], osteoarthritis [46%], and sleep disorders [35%] were significant [p<0.05] obesity related complications. Hyperlipidemia, hypertension, diabetes mellitus, gallstones, ischaemic heart disease, osteoarthritis and sleep disorders are common obesity related complications in subjects of age range 50-59 years

12 years audit of upper gastrointestinal endoscopic procedures

Evaluation of upper gastrointestinal [GI] endoscopy in terms of indications, diagnostic efficacy, and diseases diagnosed. Design: Retrospective, observational case series. Place and Duration of Study: DHQ Teaching Hospital, Rawalpindi, from March 1990 to December 2001. Subjects and Patients who underwent upper GI endoscopy in 12 years were included. Upper GI endoscopies were performed according to standard protocol. Endoscopic diagnoses were based on widely accepted criteria. Of the 8481 patients, 4935 [58.2%] were female and 3546 [41.8%] male. Mean patient age was 40.5 years. Dyspepsia [42.6%], upper GI bleed [32.8%], and evaluation of chronic liver disease [10.2%] were common indications of the procedure. An endoscopic diagnosis was possible in 82.6% patients. Varices, gastritis, duodenitis, and combined lesions were common endoscopic diagnosis. Gastritis and duodenitis were most frequent causes of upper GI bleed. We noted more gastric ulcers compared to duodenal ulcers. Females had significantly more normal endoscopies, p-value= 0.02. Upper GI endoscopy is an effective procedure. Dyspepsia evaluation is commonest indication for upper GI endoscopy in our patients. Etiology of upper GI bleed, and incidence of duodenal ulcer compared to gastric ulcer in our patients are different than described in literature. Females have significantly more normal endoscopies