[show abstract][hide abstract] ABSTRACT: Objective: To study the incidence, pattern of injuries, presentation and management of stray bullet injuries. Methods: All patients presented and admitted with stray bullet injuries during a period of 4 years from January 2006 to December 2010 were included in this prospective study which was conducted at Liaquat University of Medical and Health Sciences Hospital Hyderabad/Jamshoro. All of the study subjects were admitted through casualty and were initially thoroughly examined and resuscitated. The pattern of injuries was noted and requisite investigations performed. Patients who sustained injuries demanding surgery were prepared accordingly and were submitted for laparotomy or other procedures depending upon the severity of injuries. The data collected on individual basis and variables studied including demographics, pattern of injuries, time since injury occurred and management. Results: A total number of 165 patients with a mean age of 17.1 years, SD 13.807 and range of 74(2-76) presented with stray bullet injuries during study period. The study population comprised 117(70.90%) males and 48(29.09%) females. Majority of the patients were brought late because of delay in diagnosis or delay in transportation. The commonest victims were young children in their teens and comprised 78% of the study population. Haemothorax/ pneumothorax or peritonitis was the common presentations occurring in 11% and 61.81% of the study population respectively. Of the total number, 92 (55.75%) patients underwent laparotomy while remaining patients either had chest intubation or some other procedures done accordingly. Nine (5.45%) patients developed permanent disabilities while 13(7.87%) patients died either immediately after arrival or later on in the hospital during or after the operative treatment. Mortality was related to the time of arrival in hospital since the injury and thus was highest among those brought 4 or more hours after the shot (P<0.001). Patients who did not sustain major injuries were kept under observation and were subsequently discharged. Conclusion: Stray bullet injuries are an ever increasing challenge in our society. Unlawful and jubilant use of weapons in celebrations, weddings and similar occasions are causing a lot of morbidity and mortality in the society.
Pakistan Journal of Medical Sciences Online 09/2013; 29(5):1178-81. · 0.10 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objective: To assess the cause of pain on diagnostic laparoscopy in women with chronic pelvic pain and equivocal clinical and ultrasound examination. Study Design: Cross-sectional observational study. Place and Duration of Study: Red Crescent General Hospital, Hyderabad, Sindh, from January 2007 to December 2009. Methodology: All the women presenting with chronic pelvic pain for more than 6 months duration, without any obvious pathological findings on clinical as well as on ultrasound examination were recruited. Women with chronic pelvic pain and having pelvic pathological lesions detected on clinical and/or ultrasound examination were excluded. Clinical, ultrasound, and laparoscopic data was collected and analyzed on SPSS version 14. The results were described as frequency, proportion, compared by chi-square test with significance at p < 0.05. Results: Highest frequency of chronic pelvic pain was observed in women aged between 26 - 35 years (62.4%), 53 out of 85 women. Most of these women were married (90.6%) and nulliparous (47.1%). Pain was reported as dull and sharp by 35 women (41.2%), infertility (n = 46, 54.1%) and dyspareunia (n = 45, 52.9%) were the commonest co-existent complaints. On laparoscopic examination, pathological lesions were detected in 65, tuberculosis in 17 (20%) endometriosis in 11 women (12.9%), pelvic inflammatory diseases and pelvic adhesion in 8 (9.4%) women each and ovarian cyst in 6 women (7.1%). Conclusion: Positive laparoscopic yield was high in women with pelvic pain. Pelvic tuberculosis was the most common pathology detected followed by endometriosis, pelvic inflammatory disease and adhesions.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 03/2013; 23(3):190-3.
[show abstract][hide abstract] ABSTRACT: Abdominal tuberculosis is extremely common in developing countries such as Pakistan and India. The presentation is varied and nonspecific, making the diagnosis extremely difficult at times. This study was performed to find out the efficacy of diagnostic laparoscopy in establishing the histopathological diagnosis of abdominal tuberculosis.
An analytical descriptive study of 109 patients with abdominal tuberculosis diagnosed by laparoscopy was conducted over a period of 5 years (between January 2004 and December 2009) in a teaching hospital and in various private hospitals. All patients with vague abdominal symptoms and suspicion of abdominal tuberculosis were admitted and examined thoroughly. Data were collected and statistically analyzed using SPSS version 16.
A total of 133 patients with vague abdominal symptoms and an unsettled diagnosis were included in this series, of which 109 (82%) patients were diagnosed with abdominal tuberculosis on laparoscopy. The common symptoms were pain in abdomen, changing bowel habits, loss of weight, and generalized weakness. Clinical examination was not significant, except for anemia in the majority and generalized abdominal tenderness in a few patients. Various tuberculous lesions were detected on laparoscopy. Biopsy of the specimens proved abdominal tuberculosis in 109 patients. Patients were saved from unnecessary laparotomies and were managed on antituberculosis drug therapy.
Diagnostic laparoscopy is an efficient and reliable diagnostic tool for patients suspected with abdominal tuberculosis.
[show abstract][hide abstract] ABSTRACT: To investigate the pattern of presentation, severity, factors responsible for delayed presentation and outcome of breast cancer in patients presenting to a teaching hospital of Jamshoro.
It's a prospective descriptive study of 103 malignant breast lumps treated at a tertiary care teaching hospital over a period of 8 years. All patients were admitted through Outpatients department and were thoroughly examined and investigated. Treatment offered was based on triple assessment and ranged from lumpectomy to toilet mastectomy depending upon the stage of disease. The variables studied were recorded on a proforma and analyzed on SPSS version 12 for measuring frequencies and using Chi square test where applicable.
The mean age of the study population was 39.17 +/- 6.019 years and a range of 22 to 54 years. The frequency of advanced malignancy was alarmingly high in younger patients. Intra- ductal carcinoma was the commonest tumour in 93 (90%) patients, while the remaining included lobular (07) and Paget's disease (03). The high figures of advanced disease at presentation is attributed to lack of knowledge and education, poverty and local customs of women not exposing themselves even to the physicians. In addition, there is a substantial delay in the referral of patients from under privileged, remote areas where patients continue to receive symptomatic treatment till such time that disease becomes incurable.
Advanced breast disease is common in younger patients belonging to underprivileged and remote rural areas. Great efforts are required to educate people so as to make early diagnosis possible
Journal of the Pakistan Medical Association 09/2010; 60(9):718-21. · 0.41 Impact Factor
[show abstract][hide abstract] ABSTRACT: To study the spectrum of presentation and outcome of different treatment modalities in Fournier's gangrene.
It's a prospective analysis of 73 diagnosed patients of Fournier's gangrene admitted and treated in surgical department of a public sector university from June 2000 to June 2008. All patients were admitted through casualty with varying proportions of necrotizing infection of the perineal and genital fascia, with gangrene of the overlying skin. After resuscitation and preliminary investigations, including culture of the necrotic tissue, the patients were treated either conservatively by broad spectrum antibiotics, cardiopulmonary support, nutritional and fluid support or surgically by repeated aggressive wound debridement under anaesthesia. The behaviour of the disease, different modalities of treatment offered, response and outcome of the management were all collected on a proforma for statistical analysis on SPSS version 12.
Seventy three patients with a mean age of 57.32 +/- 13.87 years and range of 33-86 years presented with varying degrees of Fournier's gangrene. Of the total population, 67 (91.78%) were males and 6 (8.213%) were females. Fifty nine (80.82%) patients had one or the other co-morbidity with maximum number (n = 44, 60.2%) having diabetes mellitus. State of diabetes control was found to be an important prognostic factor. A source of infection was identified in skin, ano-rectal and perineal regions in 42 (57.53%) patients. Thirteen (17.80%) patients died despite aggressive conservative or surgical treatment.
Fournier's gangrene continues to be a lethal disease despite overall improvement in the antibiotic spectrum and surgical techniques. Diabetes remains the most important prognostic factor in the outcome of disease.
Journal of the Pakistan Medical Association 08/2010; 60(8):617-9. · 0.41 Impact Factor
[show abstract][hide abstract] ABSTRACT: To study the out come and benefits of an early surgical intervention in postoperative entero-cutaneous fistulae.
It's a retrospective descriptive study conducted at department of surgery LUMHS from Jan 2001 to November 2008. Two hundred and thirteen (213) post-operative fistulae are included as study subjects while those due to inflammatory bowel diseases, road traffic accidents or following blunt, stab or gunshot abdominal trauma are excluded. An aggressive treatment to build up nutritional status, correction of anaemia and control of sepsis was followed by surgical intervention as soon as the patient's condition permitted. Variables such as type of fistula, out put per 24 hours, duration since development, complications due to fistula, nutritional status, operative procedure, operative time, post-operative complications, total post-operative stay, follow up schedule, outcome. The results were statistically analysed on SPSS-12.
A total 213 patients comprising 184 males (85.6%) and 29 (13.5%) females with a mean age of 36.08 years and a range of 64 (78-14) years presenting with post-operative enter-cutaneous fistula are included in the study. Maximum number of patients (171, 79.5%) developed fistula between 4th-6th postoperative day and a vast majority of fistula occurred in the ileum (207, 97.18%) either as a result of anastomotic failure (103), leak from primary closure (99) or from un-noticed missed perforations (5). Of the total number, 24 patients eventually died making a mortality of 11.2%. Early surgical intervention proved life saving (p < 0.001). A strong relation was found pre-operative albumin levels and surgical closure of the fistula (p < 0.001) and associated mortality (p < 0.001).
High out put fistula is unlikely to close spontaneously on conservative measures. Early surgical intervention can be life saving.
Journal of Ayub Medical College, Abbottabad: JAMC 01/2010; 22(4):37-40.
[show abstract][hide abstract] ABSTRACT: To study the changing pattern of acute intestinal obstruction at a teaching institute.
It is a prospective descriptive study conducted at a teaching hospital during the period from June 2004 to June 2009. All patients with clinical or radiological evidence of acute intestinal obstruction were included in this study regardless of the gender of the patient. Patients below the age of 10 years were excluded from the study. The treatment strategy was planned ranging from conservative treatment to emergency laparotomy after resuscitation and rehydration of the patient. Details of individual patients were recorded on a pro forma sheet and data analyzed statistically on SPSS version 14.
A total of 229 patients with acute intestinal obstruction were admitted and treated. The mean age of the study population was 43.08 ± 13.07 years. Postoperative adhesions accounted for 41% (n = 95) of the total cases, followed by abdominal tuberculosis (25%, n = 58), obstructed/ strangulated hernias of different types (18%, n = 42). There was an obvious change in the pattern of etiology of acute intestinal obstruction as the common causes were postoperative adhesions and abdominal tuberculosis instead of obstructed inguinal hernias.
An increase in the adhesive obstruction and a concomitant decrease in the incidence of obstructed hernias indicate a changing trend towards early operation before it gets complicated. Abdominal tuberculosis is emerging as another common cause of acute bowel obstruction.
Saudi Journal of Gastroenterology 01/2010; 16(4):272-4.
[show abstract][hide abstract] ABSTRACT: To study various factors influencing outcome of open hernia repair in elderly population.
This is a retrospective descriptive study from January 2004 to December 2008 including all patients (n = 212) of 60 years and above operated for inguinal hernias either electively or in emergency during this period. One of the co-authors was assigned the duty to collect the record files of all patients over 60 years age operated for inguinal hernia in the department of surgery LUMHS as well as in private hospitals in Hyderabad. The records of all patients were reviewed and data retrieved on a proforma mentioning variables to investigate the common co-morbidities and their influence on the overall results of surgical intervention in geriatric patients. SPSS version 12 was used for statistical analysis of the data.
The mean age of the patients in this series was 69.82 +/- 7.8 years of whom 208 (98%) were males and 4 (2%) females. In 190 (89.61%) patients the hernias were unilateral while 12 (5.7%) cases had bilateral inguinal hernias and 10 (4.7%) patients presented with recurrent hernias. In 159 (75%) patients the hernia was simple while 53 (25%) patients presented with one or the other complication such as obstruction or strangulation. Elective surgery was performed in 161 (75.9%) patients while 51 (24.1%) patients were operated in emergency. Co-morbidities were present in 79 (37.26%) patients. Out of the total study population, 7 (3.30%) patients died of which 6 were operated in emergency and had co-morbidities. All of them had gangrene of bowel for which resection and anastomosis was done. One patient died of acute MI on 5th post-operative day.
Emergency hernia surgery carries a high mortality in elderly patients. Co-existing medical problems make surgery still challenging in the geriatric population. An early elective hernia repair is highly recommended.
Journal of the Pakistan Medical Association 01/2010; 60(1):45-7. · 0.41 Impact Factor
[show abstract][hide abstract] ABSTRACT: Laparoscopic appendectomy (LA) is categorized into intracorporeal appendectomy (ICA) and video-assisted extracorporeal appendectomy (VAECA). This study is conducted to compare feasibility and effectiveness of video-assisted extracorporeal appendectomy (VAECA) with open appendectomy (OA).
This was a comparative descriptive study conducted at the Department of Surgery of Liaquat University of Medical and Health Sciences (Jamshoro, Pakistan) from June 2003 to November 2007. Two hundred and eighty-three patients of acute appendicitis were included and categorized into two groups: A and B. Group A included 150 (53%) patients operated on by the OA technique, while group B included 133 (47%) patients in whom VAECA was performed. VAECA was accomplished through three ports in the majority of patients (89%), while a few cases (11%) were completed by two ports only. Patients below 10 years of age and with suspected appendicular mass were excluded from the study. Both operative techniques and their merits and demerits were explained to all the patients and, depending upon their choice or by a simple flip of a coin, they were operated on by either of the techniques. A well-informed written consent was also taken from every patient. The results of both the groups were collected on a proforma and were compared in terms of cosmesis, total operative time, operative and postoperative complications, and total duration of hospital stay.
The mean operating time was much shorter in group B (p < 0.001), compared to group A patients. The incidence of postoperative infection was comparatively higher in OA, compared to VAECA. The rate of operative complications (p < 0.001), postoperative complications (p < 0.01), and duration of hospital stay (p < 0.001) were all significantly lower in the VAECA group. Cosmetic results were excellent in VAECA, compared to OA, as assessed by length of incision and the postoperative scar formation.
VAECA can be a good alternate option in simple cases without much adhesions or mass formation.
[show abstract][hide abstract] ABSTRACT: Despite improvement in the technique and increasing experience, complications of different nature and severity continue to occur during laparoscopic cholecystectomy all around the world. We present bile duct injuries in this series with regards to the incidence, severity and management of this problem.
Department of surgery, Liaquat University of medical and Health Sciences, Jamshoro and other private hospitals at Hyderabad city during April 2003 to December 2007.
A total of 1132 patients with symptomatic gallstone disease were included in the study regardless of their age and gender. Laparoscopic cholecystectomy by classical four-port technique performed in all cases with few amendments as per situation. Patients with growth in gallbladder and with severe associated medical or cardiac problems were excluded from the study. Details of every patient collected on a proforma and data finally analyzed on SPSS version 10.
Of total 1132 patients, 1088 (96%) were females and 44 (4%) were males with a mean age of 47.64 years. Elective laparoscopic cholecystectomy was performed in 1118 (98.7%) patients whereas emergency laparoscopic cholecystectomy was done in 14 (1.23%) patients. Various types of common bile duct injuries as well as post -operative bile leaks and their management is discussed with a view to improve upon the technique and out come.
Iatrogenic biliary injuries continue to occur despite tremendous overall improvement in technique and expertise.
International journal of surgery (London, England) 09/2008; 6(5):392-5.
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: To deteremine the incidence, nature and management of extra-biliary complications of laparoscopic cholecystectomy. MATERIALS AND METHODS: This study presents a retrospective analysis of extra-biliary complications occuring during 1046 laparoscopic cholecystectomies performed from August 2003 to December 2006. The study population included all the patients with symptomatic gallstone disease in whom laparoscopic cholecystectomy was performed. The extra-biliary complications were divided into two distinct categories: (i) Procedure related and (ii) Access related. RESULTS: The incidence of access-related complications was 3.77% and that of procedure-related complications was 6.02%. Port-site bleeding was troublesome at times and demanded a re-do laparoscopy or conversion. Small bowel laceration occurred in two patients where access was achieved by closed technique. Five cases of duodenal and two of colonic perforations were the major complications encountered during dissection in the area of Calot's triangle. In 21 (2%) patients the procedure was converted to open surgery due to different complications. Biliary complications occurred in 2.6% patients in the current series. CONCLUSION: Major extra-biliary complications are as frequent as the biliary complications and can be life-threatening. An early diagnosis is critical to their management.
Journal of Minimal Access Surgery 02/2008; 4(1):5-8.
[show abstract][hide abstract] ABSTRACT: Ingestion of foreign bodies is not an uncommon problem in our society. The patients usually ingest different types of foreign bodies either accidentally or deliberately. Rare in children but adults are not uncommonly affected and are either psychiatric patients or ingest foreign bodies accidentally. Life threatening complications may occur at times due to ingestion of sharp and pointed objects. An interesting case of ingestion of multiple injurious foreign bodies presenting with multiple small intestinal perforations is presented with review of literature.
Journal of Ayub Medical College, Abbottabad: JAMC 01/2008; 20(2):136-7.
[show abstract][hide abstract] ABSTRACT: To find out the safety profile of laparoscopic cholecystectomy in empyema of gallbladder.
Empyema of gall bladder is a severe form of acute cholecystitis with superadded suppuration. It has been considered a contraindication for the laparoscopic cholecystectomy (LC) because of fear of life-threatening complications. This study aimed to determine the safety and feasibility of LC in empyema of gallbladder.
LC was attempted in 67 patients of empyema of gallbladder within 24h. However in few cases there was a delay because of reluctance for surgery or delay in giving consent etc. The procedure was performed by standard four-port technique with few changes made to facilitate dissection according to situation.
Between April 2003 to June 2006, 970 LC performed for gallstone disease at surgical unit-1 of LUMHS by the same surgical team. Among these, 67 (6.90%) patients were diagnosed to have empyema gall bladder. LC successfully completed in 54 (80.59%) patients. In 13 (19.40%) patients the procedure was converted to open cholecystectomy (OC) due to various operative difficulties of which the most serious injuries included bleeding from cystic artery (four cases), common bile duct injury (two cases) and duodenal injury in one case. Maximum operating time was up to 160 minutes (one case). Postoperative complications occurred in 10 (18.51%) successfully operated patients. Maximum patients (n=45, 83.33%) were discharged in 48-96 hours while three patients were discharged after two weeks.
Laparoscopic cholecystectomy can be performed in empyema of gallbladder keeping in mind a slightly increased risk of complications even in the best hands. However, the experience of the surgeon plays a key role in the overall outcome.
Journal of Minimal Access Surgery 04/2007; 3(2):52-6.
[show abstract][hide abstract] ABSTRACT: Advancing age with its associated co-morbidities increases the likelihood of postoperative complications as well as conversion rate during laparoscopic cholecystectomy. Recent studies have also questioned efficacy of this procedure in geriatric patients. The present study assesses the safety and applicability of laparoscopic cholecystectomy in geriatric patients. The objective of the present study was to asses safety and applicability of laparoscopic cholecystectomy in the elderly patients of 65 years and above.
This is a prospective analysis of 173 patients, over 65 years of age, who underwent laparoscopic cholecystectomy from December 2002 to November 2006 at Liaquat University Hospital, Jamshoro. Patients presenting with complicated and uncomplicated gallstone disease were included in the study population and all of them were operated laparoscopically. The data included demographic details, co-morbidities, underlying biliary pathology, indications for surgery, operative and postoperative complications, morbidity and mortality, and hospital stay. The statistical analysis of the data performed on SPSS version 10.
Laparoscopic cholecystectomy undertaken in 173 elderly patients with a mean age of 69.72 years, out of whom 52 (30.05%) were males and 121 (69.94%) were females. Co-morbid conditions were identified in 53.17% (n = 92) patients and included hypertension in 38 patients (21.96%), Diabetes Mellitus in 23 patients (13.29%), COPD in 19 (10.98%) patients, Coronary artery disease in 9 (5.20%) and cardiac arrhythmias in 3 (1.73%) patients. Indications for surgery included simple biliary colic in majority of patients (69.94%) and complicated stone disease in 52 (30.05%) subjects. There were 37 (21.38%) emergency laparoscopic cholecystectomies and 136 (78.61%) patients were operated electively. Mean operative time was 100 minutes with a SD 29.03. Fourteen (8.09%) patients required conversion to OC (Open Cholecystectomy) due to various reasons. Mean hospital stay was 6.28 days. Overall 23 (13.29%) patients developed postoperative complications. One patient died of acute MI on 2nd postoperative day.
There is no undue risk in laparoscopic cholecystectomy in the elderly population and the procedure can be regarded as safe as in patients below 65 years of age.
Journal of Ayub Medical College, Abbottabad: JAMC 01/2007; 19(4):45-8.
[show abstract][hide abstract] ABSTRACT: The groin hernia repair is one of the common operations in general surgery. The optimum repair method is under debate and the best mode of repair is yet to be decided. This study is conducted to compare the results of open non-mesh (Modified Bassini's) and Lichtenstein's mesh repair of primary inguinal hernia in terms of recurrence, postoperative complications and quality of life in the long-term.
This retrospective comparative analytical study includes 840 patients of which 40 patients were excluded from the study due to various reasons. The remaining 800 patients with unilateral primary inguinal hernia, above 16 years of age, operated during January 2000 to December 2007 in a teaching hospital are included in the study. Of the total number, 392 patients (49%) underwent Lichtenstein mesh repair, while remaining 408 patients (51%) were operated by modified Bassini's suture technique. Follow up was conducted 1, 5, 8 and 15 days; 1, 2, 6, 24 and 36 months.
The recurrence rate and postoperative pain were significantly low in Lichtenstein mesh repair compared to open non-mesh repair by modified Bassini's technique (p < 0.001). Recurrence occurred in 8 (2.0%) out of 392 patients those with Lichtenstein mesh repair. On the other hand 29 (7.1%) patients with Bassini's repair reported recurrence within 3 years time.
Mesh repair of inguinal hernia is much superior to non-mesh repair in terms of recurrence and postoperative chronic pain.
Journal of Ayub Medical College, Abbottabad: JAMC 21(1):17-20.
[show abstract][hide abstract] ABSTRACT: Ovarian tumours are one of the common malignancies all over the world affecting all age groups. This study analyses different clinical presentation and management of ovarian tumours in young girls up to 20 years.
Patients up to 20 years of age admitted with the diagnosis of ovarian tumour were included. Data collected on a proforma. Variables studied included age, presenting symptoms, investigations, surgical findings, type of surgery, histopathology reports and follow-up. The patients with malignant ovarian tumour were followed by oncologist as well as gynaecologist. Data analysis was done on SPSS.
The mean age was 17.27 +/- 2.46 SD years. The common symptoms included abdominal mass, abdominal pain, urinary problems, menstrual irregularities and generalized malaise. All patients were operated after preliminary investigations. Patients were advised to have follow-up post-operatively after 1 month. The follow up was done by oncologist and gynaecologist. Six patients (12.5%) died and 22 (45.83%) were lost to follow up.
Ovarian tumours are quite common in young girls. Majority of patients seek medical advice once the disease becomes symptomatic, complicated or advanced disease in the case of malignancy. Histopathology of the tumours revealed that epithelial cell tumour is the commonest tumour in contrast to germ cell tumour as reported by world literature.
Journal of Ayub Medical College, Abbottabad: JAMC 20(4):14-7.
[show abstract][hide abstract] ABSTRACT: Breast cancer is most common in females affecting nearly one out of nine women sometimes in their life. The main objective of this hospital based study was to find out the pattern of benign breast lumps in young Sindhi females. Out of the total 800 females who attended the surgical out-patient departments of Liaqua t university medical and health sciences between March 2004- February 2006, 500 young females aged between 15-25 year were diagnosed with breast lump/lumps(with or without pain) and these were included in the study. FNAC was carried out on every patient for correct histopathological diagnosis. Out of 500 patients, 294 (59 %) had benign breast lump/lumps. Among these included 66.3% with fibrocystic disease along with adenosis; 11.5% with fibroadenoma along with adenosis; 8.1% with solitary fibroadenoma; 6.12% with unilateral multiple fibroadenomas; 3.7% with bilateral fibroadenomas; 3.4% with recurrent fibroadenomas and 0.68% patients came with stromal lumps. The results of this study suggest that the pattern of benign breast lump is changing in young Sindhi females from fibroadenomas to adenosis and fibrocystic disease.