Incidental thyroid carcinoma in multinodular goitre

This study aims to determine the diagnosis of incidental thyroid carcinoma in patients operated on for multinodular goitre. Descriptive. Surgical Department, Nishtar Hospital Multan during January 2005 to June 2006. Study was carried out on 100 patients of either sex, above the age of 14 years with euthyroid multinodular goitre. Of the 100 patients of multinodular goitre, 89 were females, with female to male ratio of 8.09:1. The pressure symptoms were present in 28 patients, commonest one was dyspnoe in 18%. Swelling was bilateral in 82 patient with retrosternal extension in 6%. Thyroid carcinoma was reported in 11% patients during histopathology after subtotal thyroidectomies. The most common malignancy was papillary carcinoma with 54.54%. papillary to follicular ratio was 2:1. Postoperative complications occurred in 8 patients, wound infection 4%, temporary hoarseness 3% and Hypoparathyroidism 1%. No patient required reexploration due to postoperative haemorrhage. Mortality was nil. Risk of malignancy in MNG should not be underestimated and dominant nodules in multinodular goitre should be valued as solitary nodule

Comparative study of primary repair versus ileostomy in patients of typhoid perforation

To evaluate the better surgical option in cases of typhoid perforation comparing ileostomy and the primary repair. It was a cross sectional comparative study. Department of Surgery, Nishtar hospital Multan during December 2003 to November 2004. A total of 50 cases of typhoid perforation which presented in less than 24 hours after perforation. The patients were divided into two groups of 25 patients each in double blind randomized pattern. In one group ileostomy was done and in the other group primary repair was done. The mortality rate in the ileostomy was 8% and the morbidity rate was 56%. In the patients with primary repair the mortality rate was 12% and the morbidity rate was 24%. If patient present within 24 hours after perforation provided that the patient is in good general health and with no other concomitant illness primary repair of the typhoid perforation should be done in every patient

Presentation of gallbladder carcinoma and its surgical management

To study the mode of presentation, age and sex distribution, socio-economic status and evaluation of various surgical methods adopted for treatment of localized and advanced gallbladder carcinoma. It was a prospective type of study. This study was conducted in the Department of Surgery Nishtar Hospital, Multan from January 2004 to June 2005. Patients and methods: Twenty five patients of all ages and both sex were taken from all surgical units. On the basis of history, examination and laboratory investigations they were suspected of having gallbladder cancer. All the patients were operated and were divided into three groups on the basis of operative findings and stage of disease. There were 4 males and 21 female with a male to female ratio of 1:5. Presenting feature in decreasing order of frequency were; pain in right hypochondrium in 88%, nausea and vomiting in 60%, weight loss in 40%, jaundice in 28%, anorexia in 28%, mass in right hypochondriu m in 24%, pruritis in 20%, fever in 12% and ascites in 4% patients. Preoperative diagnosis of carcinoma of gallbladder was possible in 12 [48%] patients with the help of ultrasound and CT scan but all were of advanced age of disease. Gall stone were the most important etiological factor in 20 [80%] patients, obesity was found in 7 [28%] and chronic typhoid infection in 2 [8%] patients. All patients were operated. Simple cholecystecytomy was done in 4 patients of stage I and II. Extended cholecystectomy done in 6 patients of stage III. Laparotomy and biopsy of the mass and/or palliative surgery for drainage of bile was done in 15 cases of stage IV and V disease. Adenocarcinoma was the most common histological type found in 22 [88%] cases. Gallstone are the most important etiological factor in gall bladder carcinoma

Complications of repair of incisional hernia using polypropylene mesh

To find out frequency and type of complications after repair of incisional hernia using polypropylene mesh. It is a descriptive type of study. This study was conducted in surgical Unit-I and Surgical Unit II Nishtar Hospital Multan from March 2003 to February 2005. After admission of the patient a detailed history, thorough physical examination was done and a proforma filled containing information about previous operation. Investigations like complete blood examination, complete Urine examination, random blood sugar level, X-ray chest, ultrasound were performed and patients put on the operation list. Polypropylene mesh placed in retromuscular plane and patients were observed for complications. Male to female ratio was 1:1.85. Age varied from 14-70 years. 32 patients [80%] were between the age of 31-60 years. 6 patients [15%] were between the age of 20-30 years 2 patients [5%] were between the age of 61-70 years. The approximate time interval between the initial operation and appearance of hernia, predominantly in all 40 patients was within first year following surgery, in fact 27 patients developed incisional hernia within first 3 months, incidence decreased gradually over subsequent years. The most common presentation was protusion of abdomen in all patients [100%] followed by vague abdominal discomfort in 36 patients [90%] and dragging pain at hernia site in 16 patients [40%]. All patients underwent repair of incisional hernia using polypropylene mesh which was placed in retromuscular preperitoneal position. Complications occurred were wound infection in 4 patients [10%], serum collection in 2 patients [5%], prolonged ileus in 2 patients [5%], sinus formation in only 1 [2.5%], hernia recurrence in 1 patient [2.5%]. There was no mortality in study. Patients were followed up at 3 weeks, 6 weeks, 3 months, 6 months and 12 months. Mesh repair was found very effective method of dealing with incisional hernia

Delayed presentation and its effect on the prognosis of acute appendicitis

To identify the causes of delay in the presentation of the cases of acute appendicitis and its effects on the prognosis. It was descriptive type of study. The study was conducted in Department of Surgery, Nishtar Hospital Multan in one year from February 2004 to January 2005. The 50 patients of all ages and both sexes were taken from surgical wards of the hospital. They were presented with signs and symptoms of disease for more than 48 hours, but otherwise healthy i.e. not having any other serious illness. The patients were diagnosed as cases of acute appendicitis after history, examination, investigations and operation. There were 4[8%] patients who did not take any treatment. Patients who took the treatment but wrongly diagnosed were 36[72%]. Out of these 36 patients, 12[24%] patients were treated by the quacks, in 7[14%] the diagnosis was gastroenteritis, 11[22%] patients took antibiotics and analgesics from the start of the symptoms and in the remaining 6[12%] the presentation of the patients was not typical. 10 patients [20%] were diagnosed as acute appendicitis but they refused for appendicectomy. Out of these 50 cases 24[48%] were complicated. Overall perforation rate was 30%. Patient presenting with gangrenous appendicitis were about 6%. Appendicular mass formation was found in 4% cases. Patients presenting with generalized peritonitis were 6%. Appendicular abscess formation was in 2% cases. The duration of hospitalization was 3 days in uncomplicated cases, while in complicated cases it was 6.5 days. The high rate of complications of appendicitis with its subsequent sequelae of increased morbidity and resource expenditure is the result of patients delay in seeking medical attention