Critical view of safety faster and safer technique during laparoscopic cholecystectomy?

Objective: Incidence of Bile Duct Injuries [BDI] during Laparoscopic Cholecystectomy [LC] is reported to be higher as compared to Open Cholecystectomy. Studies have shown varying degree of success in reducing BDI by using Critical View of Safety [CVS] technique before clipping and cutting any structure. In this study, we will see whether CVS technique is faster and safer compared to conventional infundibular technique

Methods: This comparative study was conducted on patients who presented to Surgical Out-Patient-Department [OPD] of Khyber Teaching Hospital from July 2015 to June 2016. Total of 438 patients were divided into two groups. Group-A in which LC was done using infundibular while in Group-B, CVS technique was utilized. Two groups were compared for operating time and BDI

Results: The operative time was significantly reduced for LC using CVS technique [50 mins vs. 73 mins]. Minor leaks were comparable [0.5% vs. 0.9%] but there was a significant difference in major LEAKS between the two techniques [0.5% vs. 1.4%]

Conclusion: Although the "critical view of safety" requires more dissection as compared to infundibular technique, but once learnt and mastered, it is faster and safer identification technique during laparoscopic cholecystectomy

Comparison between the efficacy of topical ciprofloxacin with neomycin in the management of chronic suppurative otitis media

Objective: To compare the efficacy of topical Ciprofloxacin with Neomycin in the management of Chronic Supportive Otitis Media [CSOM]

Study Design: Randomized Clinical Trial [RCT]

Place and Duration of Study: Combined Military Hospital [CMH], Peshawar from Jan 2013 to Dec 2013

Patients and Methods: A total of 186 patients with the diagnosis of chronic suppurative otitis media were included in the study. Patients were randomly allotted to either group I that was treated by topical Ciprofloxacin eardrops [n = 93] or to group II, treated by topical Neomycin eardrops [n = 93]. Outcomes were measured by disappearance of discharge and congestion at follow-up examination. SPSS 16 was used for data analysis .Chi square test was used for analysis and p-values less than 0.05 were considered significant

Results: Topical Ciprofloxacin is more effective in earlier control of congestion and discharge of ear in CSOM; [p value = 0.001 and < 0.005 respectively] as compared to Neomycin

Conclusion: Topical Ciprofloxacin is a better drug for the treatment of CSOM as compared to topical Neomycin

Culture and sensitivity pattern of organisms in infected wounds

Objective: To find out the common bacteria causing wound infections and their sensitivity pattern to different antibiotics

Study design: Cross-sectional study

Place and Duration of Study: Bahawal Victoria Hospital Bahawalpur, from January 2014 to March 2014

Methodology: Patients with signs and symptoms of infected wounds were enrolled. Samples were collected by doctors in ward using commercially available sterile culture sticks after washing wound with saline to prevent surface contamination. The sample was sent to microbiology laboratory within one to two hours of sample collection. Culture and sensitivity pattern was performed in all the infected wounds. Data was analyzed manually and Chi square test was used to check the association of organisms with their antibiotic sensitivity pattern

Results: There were a total of sixty patients with infected wounds. Most common organism found in patients with infected wounds was Klebsiella [40%] followed by Pseudomonas [25%], Staphylococcus aureus and Echerichia coli, both 13.33%, and then Proteus [8.33%]. All these bacteria were resistant to most of the routinely used antibiotics

Conclusions: Most common bacteria cultured from infected wounds were Klebsiella and Pseudomonas. These were found sensitive to combination of cefoperazone and sulbactam, tazobactam and ciprofloxacin

Management of suicidal cut throat-a case report

Suicide is one of the 10 leading causes of death in the world, accounting for more than 400,000 deaths annually1. Hanging, poisoning and fire arm are the most common methods of committing suicide in the world. Knives and razor blades are the common implements used in suicide2. Tentative marks were present in most fatalities3. Suicide by cutting one's own throat without hesitation cuts remains rare. Such life threatening injuries require emergency treatment3,4. Here we present a case of young individual presenting in ENT department Combined Military Hospital [CMH] Quetta with a suicidal cut throat injury, using a long bladed knife

Submandibular gland involvement in early stage oral cavity carcinomas: can the gland be left behind?

To determine the frequency of submandibular gland involvement in early oral cavity tumors. Observational study. ENT Department, CMH, Rawalpindi, from January 2008 to December 2011. Data of 110 oral cavity tumors operated over 2008 - 2011 was retrieved from ENT OPD, tumor registry in AFIP and from Head and Neck Oncology Forum Registry. Cases of oral cavity tumors that had undergone elective neck dissections were retrospectively studied for invasion of the submandibular gland, TNM Staging, perineural, perivascular, lymphovascular invasion, site specific frequency of oral cavity tumors and frequency of lymph node metastasis. Tumors of tongue were the most common constituting 42%, squamous cell carcinoma was the histological diagnosis in 90% cases. Sixty eight [61.8%] cases were node negative. Selective neck dissection was done in 55.5% of the cases. Submandibular gland was involved in 2 cases [1.8%]. Submandibular gland metastasis from early oral cavity tumors is rare; any neoplastic involvement of the gland usually occurs via direct spread