Frequency of raised urinary trypsinogen-2 in acute pancreatitis

Objectives To determine the frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis

Methodology Settings Patients in emergency refer to General Surgery ward-3 Jinnah Post Graduate and Medical Centre Karachi. Duration Six months, started from 20-01-2012 to 19-07-2012. Study Design Cross sectional descriptive study. Subjects and Methods All cases of Acute Pancreatitis diagnosed by Upper Abdominal Pain, Raised Serum Amylase and/or Serum Lipase and Abdominal CT Scan findings, were included in the study. Urinary Trypsinogen-2 dipstick test was done. All patient related data including age, gender, sex and raised Urinary Trypsinogen-2 or normal, was recorded. Data analysis was done on SPSS version 10. Frequency and percentage was calculated for gender and raised trypsinogen-2. Age and gender wise stratification was done to see the effect of these variables on outcome

Results Mean age of the patients was 38.14 +/-7.42 years. The minimum age was 24 years, while the maximum age was 63 years. Raised urinary trypsinogen-2 level was present in 55 [65.5%] patients. Stratification of age group shows, that 40 [66.7%] patients in age group

Conclusion The frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis was found to be high

Tuberculosis of intestine

Objective: to determine the clinical spectrum and surgical outcome of gastro-intestinal tuberculosis

Study design: descriptive case series

Place and Duration of study: department of General surgery ward 3 Jinnah Postgraduate Medical Center [JPMC] Karachi, from June 2010 - July 2015

Methodology: all patients who were diagnosed as cases of gastrointestinal tuberculosis and underwent operative procedures were included. Data was collected on a structured proforma. The variables collected included age of the patients, gender, clinical presentation, surgical procedures performed and outcome

Results: a total of 100 patients were managed. There were 67 female and 33 male patients. Female to male ratio was 2:1. The minimum age was 13 year and maximum 50 year with the mean age of 32 year. Apart from the constitutional symptoms like nausea, vomiting and low grade fever, abdominal pain was the commonest presentation. Eighty-eight patients were operated. End ileostomy, limited right hemicolectomy and resection anastomosis with primary repair were the commonly performed procedures. Two patients developed enterocutaneous fistulae. Five patients presented with septic shock and died

Conclusion: intestinal TB had varied presentation. It was found more frequently in females. Fever and weight loss were common presentations. High index of suspicion must be exercised in making a diagnosis

Comparison of fistulectomy with fistulotomy in low fistula in Ano

Objective: To compare the outcomes in terms of healing after fistulotomy and fistulectomy for low lying fistulae in ano

Study design: Cross sectional analytic

Place and Duration of study: Department of Surgery, Surgical Unit I, Jinnah Postgraduate Medical Centre Karachi, from June 2013 to May 2015

Methodology: Patients of both genders between 12 to 60 year of age with clinical diagnosis of fistula in ano were included in the study. Pain was assessed on visual and analog scale [VAS] Hospital stay was also recorded. All were followed for four week for any complications

Results: During the study period 120 patients were enrolled. Out of these 60 patients had fistulotomy and 60 underwent fistulectomy for fistula in ano. Male predominated with male to female ratio of 3:1. Swelling [86.6%], discharge [37%] and itching [27%] were the common symptoms. The mean duration of hospital stay was 3 +/- 1 day. Postoperative wound healing and pain assessed by VAS, were high in fistulectomy group. All patients recovered during follow up except one who continued to complain incontinence from fistulectomy group

Conclusion: Fistulotomy yielded better results as compared to fistulectomy for the treatment with low fistula in ano

Recurrent laryngeal nerve palsy and hypocalcemia with and without bilateral ligation of inferior thyroid artery in total thyroidectomy

Objective: To find out frequency of recurrent laryngeal nerve palsy and hypocalcemia with and without bilateral ligation of inferior thyroid artery [ITA] in total thyroidectomy

Study design: Descriptive case series

Place and duration of study: Department of General Surgery ward 3, Jinnah Postgraduate Medical Center Karachi, from April 2010 to April 2015

Methodology: All patients of non toxic multimodular goitre who had indication for surgery were included. Patients were divided in two groups. In group I patients ITA was ligated and in group II it was left alone during total thyroidectomy. Postoperatively serum calcium level was done after 24 hours, 48 hours and on Day 7. Voice changes were also noted. If hypocalcemia and voice changes recovered within 6 months then the condition was labeled as transient phenomenon. If changes persisted then it was considered permanent insult

Results: There were 100 patients of non toxic multimodular goitre in this series. Age range was from 12 year to 65 year. In each group there were 48 females and 2 males. In group I 12 [24%] patients developed transient hypocalcemia and 3 [6%] had transient recurrent laryngeal nerve palsy. In group II 10 [20%] developed hypocalcemia and 7 [14%] had recurrent laryngeal nerve palsy. All were transient in nature

Conclusion: The frequency of hypocalcemia and recurrent laryngeal palsy was less in patents with bilateral ITA ligation

Marsupialization for simple fistula in ano

To compare the post-operative course and the outcome of marsupialized and open wounds in the patients who underwent either fistulotomy or fistulectomy for simple fistula in ano. Comparative study. Department of General Surgery Jinnah Postgraduate Medical Center Karachi, from December 2011 to May 2012. Fifty patients with simple anal fistula were included in this study. They were divided into two groups. Fistulous tracts were managed by using a fistulectomy or fistulotomy alone [group A] while a fistulectomy or fistulotomy with marsupialization was performed in group B. The primary outcome measure was wound healing time while secondary outcome measures were postoperative bleeding, postoperative pain, wound infection, anal incontinence and recurrence. Postoperative wounds in group B healed earlier in comparison to group A wounds [4.85 +/- 1.39 weeks vs. 6.75 +/- 1.83 weeks, p = 0.035]. No significant differences existed between the operating times [28.00 +/- 6.35 minutes vs. 28.20 +/- 6.57 minutes, p = 0.925] and Visual Analogue Scale scores for postoperative pain was 3.3 +/- 1.4 in group A and 3.2 +/- 1.5 in group B. Post operative bleeding was observed for a significantly longer duration in group A than in group B [4.10 +/- 1.91 weeks vs. 2.75 +/- 1.71 weeks, p = 0.035]. No patient developed anal incontinence or recurrence during the follow-up period of twelve weeks. Marsupialization of the wound after either fistulectomy or fistulotomy for simple fistula in ano results in faster healing, less bleeding without lengthening the operative time and without increasing the infection.

Excision with Z-plasty in pilonidal sinus

To measure the outcome of the pilonidal sinus exicision with Z-plasty in terms of postoperative hospital stay, recurrence, wound infection and patient's time off work. Cross sectional study. Department of General Surgery, Ward-26, Jinnah Postgraduate Medical Centre Karachi, from January 2008 to January 2009. Patients with pilonidal sinus above 12 years of age were included in this study. They were diagnosed clinically. Those with abscesses and recurrence of disease were excluded. A total of 40 patients were operated. There were 28 [72%] males and 12 [28%] females. Majority were in the age group of 21 - 30 years [64%]. The operating time ranged between 30-45 minutes [mean 35 + 2]. Mean postoperative stay was 3.5 days [2- 5 days] and return to work was between 7-18 days [mean 12.5 days]. Three patients [7.5%] patients developed wound dehiscence, 6 [15%] had wound infection and recurrence occurred in 2 [5%]. 95% confidence interval[C.I] of overall complication was 13.4-40.1. Excision of pilonidal sinus followed by primary closure with Z-plasty technique had the advantage of early wound healing, short postoperative stay and low risk of recurrence

Danazol versus oil of evening primrose in the treatment of mastalgia

To evaluate the efficacy of Danazol and Oil of Evening Primrose [OEP] in the treatment of Mastalgia, and to note their undesirable effects during the course of treatment. An open, non-randomized, comparative study, carried out from Nov 2004 to Nov 2005. Department of General Surgery, Surgical Unit-Ill [Ward 26], Jinnah Postgraduate Medical Centre, Karachi. A total of 100 female patients with moderate to severe breast pain who visited the Out-patient Surgical Department of Jinnah Postgraduate Medical Centre, Karachi. After clinical evaluation, investigations and informed consent, all patients were assigned to two groups alternatively. Mastalgia in all the patients was gauged before and during the treatment according to the Cardiff Breast pain Score [CBS]. Patients with discrete lumps, nipple discharge, lactation, pregnancy and breast abscess were excluded from the study. Group-I [n = 50] patients were given Danazol 100mg b. i. d per oral and Group-II [n = 50] Efamol [Oil of evening primrose] 500mg b. i. d per oral for three months periods. All patients were seen at 4 and 12 weeks, their level of mastalgia assessed and information sought about adverse effects of the drug. Out of the 100 patients, 70% belong to the age group 15-25 years, 20% to 26-35 years and 10% beyond 35 years of age. The overall response with Danazol was 76% in contrast to 68% response in the patients treated with OEP The patients who were treated with Danazol showed 32% distressing but reversible side effects as compared to 12% in OEP which were not distressing and also reversible. Danazol offers good pain control in mastalgia but with distressing side effects, where as Oil of Evening Primrose [OEP] also showed good pain control but without mtich distressing side effects

Carbimazole-induced hypothyroidism causes the adrenal atrophy in 10 days' prenatally treated albino rats

To investigate the effects of carbimazole-induced hypothyroidism, and simultaneous administration of thyroxine [thyroid hormone analogue] on the adrenal glands of 10 days' prenatally treated albino rats. A comparative study. Department of Anatomy, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC], Karachi, from 15th July 2001 to 31st August 2001. Ten days old albino rats of either gender, which were delivered by their respective mothers which were originally obtained from Charles River Breeding Laboratories, Brooklyn, Massachusetts, USA, and were cross bred, housed and maintained on the balanced diet in the Animal House of BMSI, JPMC, Karachi. Eighteen prenatally treated albino rats of 10 days old were used in the experiment and divided into three groups: X, Y and Z, comprising 06 animals in each group, i.e. from carbimazole treated mothers [X], carbimazole plus thyroxine treated mothers [Y], and controlled mothers [Z]. At the end of 10th postnatal day all the animals were sacrificed, their adrenal glands were removed, fixed, sectioned, and stained with H and E. The adrenal histology with relation to its width of cortex, zones and number of cells in different zones of cortex were studied. Carbimazole-induced hypothyroidism causes the adrenal atrophy in the adrenals of 10 days' prenatally treated albino rats by decreasing the total width of cortex and its zones especially zona fasciculata. Carbimazole-induced hypothyroidism by carbimazole causes the shrinkage of adrenal cortex in 10 days prenatally treated albino rats