RESUMEN
BACKGROUND: Anaemia is the commonest haematological problem in the preoperative patients. Often it is a sign of underlying disease or associated co-morbid condition. A low haemoglobin level is associated with an excess risk in surgical procedure and its outcome. Therefore an understanding of any cause, evaluation and any potential treatment is crucial in the preoperative setting. Our objective was to determine prevalence, evaluation and management of preoperative anaemia in the elective general surgical patients. METHODS: Prospective observational study in Surgical Unit-II, Liaquat University Hospital Jamshoro from July 2008 to June 2009. One hundred and twenty-five anaemic cases were included in the study, with haemoglobin level < 10 g/dl. Their age ranged from 13 to 70 years. They were evaluated for preoperative anaemia in relation to surgical problems and associated any co-morbid conditions. RESULTS: Out of 830 patients during the study period, 125 patients were anaemic with haemoglobin level 2.1-9.9 g/dl. Fifty-six (44.8%) were male and 69 (55.2%) were female, and 68.5% patients were from rural areas. Hypochromic microcytic was seen in 101 (80.8%) cases. Commonest surgical problem associated with anaemia was malignancies (27.2%) followed by haemorrhoids (20%) and tuberculosis of abdomen (14.4%). Majority of patients (52%) were managed on oral iron supplements while 48% received blood transfusions.
Asunto(s)
Anemia/diagnóstico , Anemia/terapia , Cuidados Preoperatorios , Adolescente , Adulto , Anciano , Anemia/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Prevalencia , Estudios Prospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Cholelithiasis is the most common disease of alimentary tract affecting the adult population globally and our country in particular is no exception to it as a cause of hospitalization. Surgical removal of gall bladder is the main stay of symptomatic cholelithiasis ensuring a permanent cure. The minimally invasive technique of laparoscopic cholecystectomy has gained wide acceptance as a Gold Standard treatment ever since its introduction. The purpose of this prospective observational study was to document our experience of laparoscopic Cholecystectomy during a learning curve in a single unit of a university hospital and compare it with other available data in the literature. METHODS: Total 94 patients underwent laparoscopic cholecystectomy during the learning curve from Jan 2009 to Dec 2010 in the Department of Surgery Liaquat University Hospital Jamshoro. RESULTS: Mean age was 42 years with females (88.29%) preponderance. Majority of the cases were operated by consultants (85.10%) within 25-60 minutes. Postoperative hospital stay was 3 days with return to work in 7 days. Only 6 (6.38%) cases were converted to open technique. Intra-peritoneal drains and Foley's catheter were kept in selected cases only. Eleven patients (11.70%) had intra-operative complications including complete transaction of CBD in only one (1.06%) male patient. Five patients (5.31%) had postoperative complications with two patients having iatrogenic duodenal injury which was not identified during surgery and pseudo cyst pancreas. Four patients (4.25%) died due to multiple organ failure. CONCLUSION: We conclude that Laparoscopic Cholecystectomy is a gold standard procedure and should be learned on virtual simulated models before starting this procedure on human patients.
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Colecistectomía Laparoscópica/educación , Competencia Clínica , Adolescente , Adulto , Anciano , Colelitiasis/cirugía , Femenino , Hospitales Universitarios , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Tempo Operativo , Pakistán , Estudios Prospectivos , Adulto JovenRESUMEN
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Diagnostic laparoscopy is an efficient and reliable diagnostic tool for patients suspected with abdominal tuberculosis.
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Laparoscopía/métodos , Tuberculosis Gastrointestinal/diagnóstico , Abdomen , Adolescente , Adulto , Anciano , Biopsia , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Tuberculosis Gastrointestinal/epidemiología , Adulto JovenRESUMEN
We present a case of giant gastric trichobezoar retrieved through a long gastrotomy in a 40 years old married women from rural Sindh with unreported psychological disturbance. Trichobezoar almost exclusively occur in females with an underlying psychiatric disorder. It has an insidious development of symptoms which accounts for its delayed presentation and large size at the time of diagnosis. They are associated with trichophagia (habit of compulsive hair eating) and are usually diagnosed on CT Scans or upper GI Endoscopy. They can give rise to complications like gastroduodenal ulceration, haemorrhage, perforation, peritonitis or obstruction with a high rate of mortality. The treatment is endoscopic, laparoscopic or surgical removal and usually followed by psychiatric opinion.
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Bezoares/patología , Neoplasias Gástricas/patología , Adulto , Diagnóstico Diferencial , Femenino , HumanosRESUMEN
BACKGROUND: Audit is a means of quality control for medical practice by which the profession should regulate its activities with intention of improving overall patient care. Objective of this study was to report 1 year basic clinical audit of a general surgical ward and comparison of results with available data. METHODS: All patients admitted and managed in Department of Surgery Unit-II, Liaquat University Hospital, Jamshoro/Hyderabad from January to December 2007 were included in the study for basic clinical audit. Data of all surgical patients admitted during this period were retrieved from the departmental register. Details of surgical procedures and complications were recorded from the patients' charts. RESULTS: Total number of patients was 1434, out of which 844 (58.85%) were males and 590 (41.14%) were females. Majority (70.02%) of the patients were between 16 to 50 years of age. Elective surgeries were performed in 487 (33.74%) and emergency surgeries in 430 (29.79%) cases, whereas rest of the 526 patients (36.28%) were managed conservatively. Consultant was the primary surgeon in less than 50% of the procedures compare to post graduate trainees and registrars. The most common surgeries performed in elective wing were inguinal hernia repairs (25.66%) and cholecystectomies (22.99%). In emergency wing, most of the surgeries were exploratory laparotomies (38.13%) and appendicectomies (22.79%). Average duration of hospital stay in elective wing was 1-10 days and in emergency wing it was 2-21 days. There was an overall complication rate of 6.3% and a mortality rate of 2.44% respectively. CONCLUSION: We conclude that surgical audit has potential benefits for patients, clinicians, and provision of services for a continuous education, research and improved practice habits and should be perform on yearly basis. We also recommend the proper computerised audit programs and committees for its monitoring and evaluation.
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Auditoría Clínica , Servicio de Cirugía en Hospital/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Hospitales Universitarios , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pakistán , Estudios ProspectivosRESUMEN
The case of 20 years old boy with an extra osseous Ewing's sarcoma is described. He was initially diagnosed as a case of infiltrative malignant tumour of left suprarenal gland on the basis of preoperative workup but postoperative biopsy of surgically excised specimen confirmed Extra-osseous Ewing's Sarcoma (EES) suprarenal gland with no evidence of malignancy on skeletal scintiscan, bone marrow aspirate and histopathology Suprarenal location of primary EES is unknown and probably has not been reported in literature. We report a unique case of EES.
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Neoplasias Renales/diagnóstico , Neoplasias Renales/cirugía , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/cirugía , Biopsia , Diagnóstico Diferencial , Humanos , Neoplasias Renales/patología , Imagen por Resonancia Magnética , Masculino , Sarcoma de Ewing/patología , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
An interesting case of a 09 years old girl is reported who presented with a painless, mobile, spherical, fluctuant and brilliantly translucent swelling in front of left ear. The fine needle aspiration revealed turbid dark yellow colour fluid. This cystic swelling was completely excised and the specimen on histopathology was reported as low grade Mucoepidermoid carcinoma. Recovery was uneventful. This unusual presentation of Mucoepidermoid carcinoma as a preauricular cyst is one of the rare unique reported case.