Frequency of causes of mechanical bowel obstruction

Objective: To find out the frequency of different causes of mechanical bowel obstruction

Study Design: Observational / descriptive study

Place and Duration of Study: This study was carried out the Surgical B Unit of MTI, Lady Reading Hospital Peshawar from March 2015 to December 2015 Patients and Methods: All the patients presented with signs and symptoms of bowel obstruction were included in the study while those with non mechanical bowel obstruction like paralytic ileus and peritonitis were excluded from the study. Patient's demographic features and all the data were recorded

Results: Total 50 patients were included in the study. The age range of the patient was 15-80 years with mean age was 42,98 +/- 17.60 years. Thirty seven 74% patients were male and 13 [26%] were female constituting male to female ratio of 2.84:1. Out of 50 patients operated for mechanical bowel obstruction, commonest cause of bowel obstruction was post operative adhesions which accounted for 17 [34%] followed by sigmoid volulus in 10 [20%] cases and intestinal tuberculosis in 8 [16%] patients

Conclusion: Adhesions and sigmoid volvulus were the common causes of intestinal obstruction

Although patients presenting with sub acute intestinal obstruction can be treated conservatively initially, should they develop signs and symptoms of gut ischemia, when conservative treatment fails or in most cases of acute intestinal obstruction immediate surgical exploration is still required

Frequency and causes of conversion of laparoscopic cholecystectomy into open cholecystectomy

To determine the frequency and causes of conversion of laparoscopic cholecystectomy into open cholecystectomy. Cross-sectional [descriptive] study. This study was carried out at Surgical Unit of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar for 14 months, from 1-11-2010 to 31-12-2011. A total of 126 patients of symptomatic gallstones disease fulfilling the inclusion criteria were subjected to laparoscopic cholecystectomy and were followed through out the procedure to see for any conversion and its cause. The mean age of patients was 40.65 +/- 10.35 with range of 20-65 years. The total no of cases converted to open cholecystectomy were 11 out of 126. Thus frequency of conversion was 11 equal to 8.7%, with commonest cause being adhesions 9 out of 11 converted cases followed by hemorrhage 2 out of 11 conversions. Moreover conversion was more in male patients. 20.8% as compared to 5.9% in females. Laparoscopic cholecystectomy is the gold standard treatment modality in the management of symptomatic gallstones disease. Its one disadvantage is the conversion into open procedure. But conversion should not be considered as complication of the procedure rather it is mature decision by the surgeons to avoid unnecessary lengthening the duration of surgery once they encounter any difficulty or interoperative complication

Frequency of diaphragmatic trauma in fire-arm injury of abdominal cases and outcome of its management

To determine frequency of diaphragmatic trauma in fire-arm injuries of abdomen and to determine outcome of its management. Retrospective study. This study was conducted at Department of Surgery, Unit B, Lady Reading Hospital Peshawar over a period of one year from January 2014 to January 2015. Record of all fire-arm injury cases, who presented during study period, was analyzed. Data were collected on pre-designed proforma from admitted patient record [patients charts] and operation theatre notes register. Demographic data, site and frequency of injury to diaphragm, operative findings, and outcome were the variables of study. Out of total 83 patients of fire-arm injuries, 14 [16.8%] patients had diaphragmatic trauma. Mean age of patient was 27.14 years. Male to female ratio was 4.9:1. Left dome of diaphragm was injured in 9 [64.28%] and right dome was involved in 4 [28.57%] of cases and in one patient [7.14%] patients central tendon of diaphragm was injured together with injury to pericardium that got expired. Diaphragmatic injury though not as common in abdominal fire-arm injury. There should be however very low threshold for suspicion in cases of fire-arm injury of abdomen, where bullet trajectory or mechanism of injury is suggestive, because missing such injury is not devoid of complications. The patient should be thoroughly examined and investigated for exclusion of diaphragmatic injury

Trend of fertility potentials with increasing age in Pakistani males

The objective being to examine the magnitude and the shape of the relationships between age and semen volume, sperm concentration and sperm motility by keeping the other factors affecting fertility directly constant among patients undergoing infertility evaluation at National Institute of Health, Islamabad, Pakistan. This experimental study with non-probability sampling was conducted in Reproductive Physiology/Health, Public Health Laboratories Division, National Institute of Health, Islamabad during 2006-2009. A total 350 patients [21-50 years] were divided age wise into three groups [21-30, 31-40 and 41-50 years] to compare alteration in sperm count and motility. Semen profile was evaluated according to WHO reference value for normal semen characteristics. The result of Sperm concentration showed a non significant [p>0.05] decreasing trend with increasing age that was 0.047million/ml for every year where as sperm motility declined significantly with increasing age at p>0.05. Age-related decreases in semen qualities particularly decline in sperm motility revealed that men may become progressively less fertile as they age. However, unlike women, there appears to be no evidence of an age threshold for men

existence of gonadotrophin in a local system of medicine of animal origin used for contraception

Progesterone and estradiol are responsible for playing a vital role in contraception. The fertilization is prevented mainly either by inhibiting ovulation or by making the mucus of the female genital tract thick and viscid in the present study, the extracted material of "Cyprea moneta shell" has been found to contain a reasonable amount of sex steroids with small amount of gonadotrophins, The concentration of LH and FSH were 0.564 mIU/ml and 0.644 mIU/ml, respectively, as compared to the undetectable amount of gonadotrophin in medicinal plants [Abrus precatorius, Ricinus communis Crotalaria juncea, Acacia arabica and Ficus religiosa]. However, the sex steroid hormones detected in all these medicinal plants were in large amount, causing contraception

Contraception in traditional system of medicine the possible role of sex steroids on female reproduction

Contraceptive pills used in allopathic system of medicine contain both estrogen and progesterone or progesterone only. These hormones are responsible for contraception. Fertilization is prevented mainly by inhibiting ovulation or by making the mucus in the female genital tract thick and viscid. In this study different parts of five different plants, and one animal species used as contraceptive in Traditional System of Medicine, were selected to see their efficacy as contraceptive. These substances were subjected to determine the presence of steroid and peptide hormones. Electrochemiluminescence technique was used to detect these hormones in the extract. Results reveal that all the substances contain reasonable amount of steroid hormones i.e., estradiol, progesterone and testosterone ranging from 62.76 pg/ml to 313.6 pg/ml, 0.333 ng/ml to 2.90 ng/ml and 1.22 ng/ml to 22.24 ng/ml. respectively. All these substances were found to contain steroid hormones except the shell of Cyprea moneta which showed no detectable amount of LH and FSH. The concentrations of LI1 and FSH in the extract of Cyprea moneta shell were 0.564 mlU/ml ml and 0.644 mlU/ml, respectively. On the basis of these findings it is postulated that different parts of these plants and animals may create imbalance in the delicate ratio of estrogen and progesterone required for the ovulation and implantation, thus preventing fertilization

possible role of steroid hormones present in vitex negundo and its efficacy as a contraceptive

Vitex negundo is used as a contraceptive in traditional medicine. Most of the oral contraceptive pills used in allopathic medicine are the combination of estrogen and progesterone. Some contraceptive pills [mini pills] contain progesterone alone. The present study shows that the extract of Vitex negundo contains estrogen, testosterone and progesterone, their concentrations were found to be 947.7 pg/ml, 22.276 ng/ml and 6.022 ng/ml respectively. From these findings it is assumed that this high concentration of steroid hormones may contribute to its contraceptive action but it may have some side effects on the female reproductive physiology as it contains male hormone i.e. testosterone in addition to the progesterone and estrogen. On the basis of these findings, it is suggested that the trial of this drug on animals followed by clinical study should be carried out to see its anti-fertility activity and side effects