Frequency of peptic ulcer perforation during fasting and without fasting

Objective: To find out the frequency of peptic ulcer perforation during fasting in the month of Ramadan with non-fasting during other months

Study design: Descriptive case series

Place and duration of study: Department of Surgery Ward-3 Jinnah Postgraduate Medical Center Karachi, from January 2005 to November 2014

Methodology: The data of 220 patients who were operated due to peptic ulcer perforation, was analylsed. Patients were divided into 2 groups. Group I [n= 139] included patients who were operated in the months other than Ramadan, while group II [n= 81] included patients who were operated during the month of Ramadan. The patients of peptic ulcer due to malignancy were excluded

Results: Of the total there were 209 male and 11 female patients. Age range was 12 year to 65 year. Most of the patients [n=178 - 85%] were between 20 year to 50 year of age. Frequency of perforation was highest in Ramadan then in Shawal month and was less in other months of the year. On average patients with peptic ulcer in Ramadan were 8.1 and in non-fasting months 1.2

Conclusion: The frequency of perforation in peptic ulcer disease was higher in Ramadan month during fasting state as compared to other months of the year

CT guided percutaneous drainage of pancreatic abscess

Objective: to determine the outcome of CT guided percutaneous drainage of pancreatic abscess

Study design: descriptive case series

Place and Duration of study: department of General Surgery Unit I, Jinnah Postgraduate Medical Centre Karachi, from October 2011 to October 2015

Methodology: all patients with acute pancreatitis who developed pancreatic abscess which was diagnosed on clinical grounds and with CT scan abdomen underwent CT guided percutaneous drainage. Following aspiration fluid sent for culture and sensitivity and drain was placed in the abscess cavity. CT scan was repeated and if no residual collection found with clinical improvement of symptoms, patients were discharged. Patients who did not improve up to 40 days or clinically deteriorated and developed complications like sepsis or pancreatic fistula formation, underwent surgical intervention. Data was collected on specially designed performa

Results: five Hundred and fifty eight patients of acute pancreatitis were admitted during the study period and among them 25 [4.48%] patients developed pancreatic abscess. Four [16%] patients were male and 21 [84%] female. Mean age was 45 +/- 10 year. Twenty [80%] patients were cured with percutaneous drainage in 20 - 40 days and five [20%] developed complications for which open surgical intervention was done. One [4%] developed pancreatic fistula and one [4%] patient died. Three patients improved with surgical intervention

Conclusion: CT guided percutaneous drainage is minimally invasive and effective surgical treatment for pancreatic abscess

Morbidity and mortality in acute pancreatitis

Objective: to determine the morbidity, mortality and causes of acute pancreatitis in patients presenting to a tertiary care hospital

Study design: descriptive case series

Place and Duration of study: department of Surgery Ward 3 Jinnah Postgraduate Medical Centre Karachi, from October 2013 to October 2015

Methodology: patients diagnosed as having acute pancreatitis were included in the study. Laboratory and radiological investigation were carried out. Local, systemic complications, mortality and causes of acute pancreatitis were noted. Patients were followed up to 3 months to record the late complication of acute pancreatitis

Results: a total of 220 patients of acute pancreatitis were included. Average age of patients was 43 year. There were 150 [68.18%] female and 70 [31.82%] male patients. Of the total 176 [80%] patients had acute mild pancreatitis, 24 [10.90%] acute moderate pancreatitis and 20 [9.10%] acute severe pancreatitis. Overall mortality was 3.64% [n=8]. Mortality in acute moderate pancreatitis was 8.33% and in acute severe pancreatitis 30%. Local and systemic complications occurred in 18.33% patients. This included ARDS [20%], pleural effusion [20%], hypocalcaemia [20%], shock [18.8%], neurological [13.63%] and renal failure [13.63%]. In 85% cases cause of acute pancreatitis was cholelithiasis

Conclusions: overall mortality in acute pancreatitis was 3.64. It was more in cases of acute severe pancreatitis. The major cause of acute pancreatitis was cholelithiasis

Phyllodes tumors of breast: a review of 30 cases

To describe clinical features, histopathology, treatment and prognosis of phyllodes tumor of breast. Descriptive case series. Department of Surgery, Jinnah Postgraduate Medical Centre Karachi, from 2005 to 2011. This is a retrospective review of the medical records of patients managed over a period of six years. The data of patients with phyllodes tumor [PT] of breast were analyzed for age at the time of diagnosis, the duration of the illness, tumor size, tumor localization, ultrasound features, preoperative diagnosis, surgical procedure, pathological grading and outcome. Grading of tumor was done according to the World Health Organization [WHO] classification. The age of the patients ranged from 19 year to 66 year [mean age 40 year]. The mean age of occurrence of benign, borderline and malignant tumors was 35.5, 44.5 and 45.6 year respectively. The mean time from onset of symptoms and pathological diagnosis of PT ranged from one to 36 months [mean 15 months]. Tumors occurred in the left breast in 12 cases, and on right side in 16 cases. The upper outer quadrant was involved in 11 [36.6%] cases. The resection margin was recorded as negative in 18 cases. Nine patients underwent postoperative radiation [3 borderline and 6 malignant PTs]. Local recurrence occurred in one benign, 3 borderline and 2 malignant cases. Treatment in the case of recurrent benign PT included lumpectomy. Mastectomy was done in 5 other recurrent cases. Phyllodes tumors of the breast have an unpredictable outcome. A wide local excision, with adequate margin of normal breast tissue, is the preferred initial therapy

Role of clinical examination and ultrasound in detecting in the size of breast lump and its corelation with pathological specimen size

To assess and compare the role of clinical examination and ultrasound in detecting the size and nature of breast lump in relation to gross pathological specimen size. Retrospective case review analytical study which was conducted in Ward-26, Jinnah Postgraduate Medical Centre, Karachi over a period of two years i.e. September, 2002 to September 2004. All female patients visited outpatient department of Ward-26 with definitive breast lump above 12 years of age were included. Fifty eight patients age ranging froni 15 - 60 years were scanned in study. Out of which 35 patients [60.3%] turned out to be benign and 23 [39.6%] patients malignant cases. The sensitivity and specificity of ultrasonography and clinical examination for benign lesion is 100% but in case of malignant disease the specificity of ultrasonography is 95.7% i.e. in one case ultrasonography did not detect the malignant condition. The digital examination and ultrasonography found comparable and correlated best with gross histopathological specimen in case of benign condition while in case of malignant lesion, tumor size assessed clinically depicted a stronger correlation [r=0.9] with pathological findings while ultrasonography underestimated 6 cases out of 23. Gold standard criteria of histopathological diagnosis confirmed that physical examination measurement remains the method of choice in evaluating the disease preoperatively. The role of ultrasonography in benign lesion is undoubtful but prediction of pathological outcome is not improved by ultrasonography in malignant conditions. The combination of physical examination with ultrasonography significantly improves the accuracy of non-invasive assessment of tumor dimensions