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1.
J Coll Physicians Surg Pak ; 33(1): 5-9, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36597226

RESUMO

OBJECTIVE: To compare intravenous lidocaine infusion adjunct to NSAID and Acetaminophen with regular analgesics for postoperative mean pain score and mean ambulation time after laparoscopic cholecystectomy. STUDY DESIGN: Randomised controlled trial. PLACE AND DURATION OF STUDY: Department of General Surgery, Islamabad Medical Complex, (IMC), from March 2020 to December 2021. METHODOLOGY: Sixty (n=60) adult patients, both males and females between the ages of 18-60 years planned for laparoscopic cholecystectomy, were selected and randomly allocated to two groups of treatment (Lidocaine and Ringer Lactate). The control group did not receive any other placebo other than Ringer Lactate infusion. Both groups received Intramuscular Diclofenac 12 hourly and intravenous acetaminophen infusion 8 hourly. Postoperative pain 2, 6, 12 and 24 hours (h) and mean ambulation time were compared in both groups. RESULTS: Mean VAS (Visual Analogue Scale) of group 1 versus group 2 at 2 h, 6 h, 12 h and 24 h were 3.47 ± 0.82 vs. 6.27 ± 0.52 (p=<0.001), 2.7 ± 0.75 vs. 4.8 ± 0.8 (p<0.001), 2.0 ± 0.49 vs. 3.93 ± 0.94 (p<0.001), 0.73 ± 0.82 vs. 2.2 ± 0.61 (p<0.001). Time for spontaneous ambulation after surgery was 5.57 ± 1.55 hours for Group 1 versus 7.3 ± 1.9 hours for Group 2 (p<0.001). CONCLUSION: Pain scores at all-time intervals were lower, and ambulation time was shorter in patients who received intravenous infusion of lidocaine as compared to patients who received only regular analgesics for laparoscopic cholecystectomy. KEY WORDS: Ambulation time, Laparoscopic cholecystectomy, Postoperative pain.


Assuntos
Anestésicos Locais , Colecistectomia Laparoscópica , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Acetaminofen/uso terapêutico , Analgésicos/uso terapêutico , Analgésicos Opioides , Colecistectomia , Colecistectomia Laparoscópica/efeitos adversos , Método Duplo-Cego , Infusões Intravenosas , Lactatos , Lidocaína , Dor Pós-Operatória/tratamento farmacológico
2.
J Pak Med Assoc ; 72(7): 1441-1443, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36156578

RESUMO

Duodenal ulcer disease is uncommon in paediatric age group. Its perforation is even rarer. However, it should be kept in mind when examining children with acute abdomen especially if there are signs of shock or possibility of upper gastrointestinal bleed. We report a case of a 6 years old female child, a known case of thalassemia major and taking oral Deferasirox since two years of age. She had atypical presentation as there was no previous history of peptic ulcer disease and she only suffered epigastric pain and vomiting for a week but due to lack of proper diagnosis at a local clinic developed duodenal ulcer perforation, which was ultimately diagnosed at a tertiary care hospital and managed with Graham Patch Closure.


Assuntos
Úlcera Duodenal , Úlcera Péptica Perfurada , Talassemia beta , Quelantes , Criança , Deferasirox , Úlcera Duodenal/induzido quimicamente , Úlcera Duodenal/complicações , Úlcera Duodenal/diagnóstico , Feminino , Humanos , Ferro , Úlcera Péptica Perfurada/diagnóstico , Úlcera Péptica Perfurada/etiologia , Talassemia beta/complicações
3.
J Coll Physicians Surg Pak ; 31(11): 1351-1353, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34689496

RESUMO

Teratomas belong to non-seminomatous germ cell tumors and originate from totipotent germ cells. They are mostly made up of tissues derived from all three layers, i.e., endoderm, mesoderm and ectoderm. They can be mature teratomas, which are benign or immature teratomas, having malignant potential. Extra-gonadal mature cystic teratomas are uncommon, particularly in retroperitoneum. Other sites are sacrococcygeal, mediastinal, and pineal regions. They are mostly detected in females in reproductive age group. In this case report, we discuss a female patient being worked up for persistent vomiting and food indigestion, initially managed on the line of acid peptic disease. She was found to have a large retroperitoneal mass in adrenal region producing mass effect on intestines. Later on, it was discovered to be mature cystic teratoma on histopathological evaluation. Key Words: Mature teratoma, Adrenal gland, Retroperitoneum.


Assuntos
Neoplasias das Glândulas Suprarrenais , Cisto Dermoide , Neoplasias Embrionárias de Células Germinativas , Teratoma , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Feminino , Humanos , Espaço Retroperitoneal , Teratoma/diagnóstico , Teratoma/cirurgia
4.
J Coll Physicians Surg Pak ; 29(10): 1006-1008, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564280

RESUMO

Chemotherapy-induced diarrhea has become a worrisome problem for the patients as well as the treating surgeons and oncologists because patient outcome is significantly affected. Necrotising enterocolitis is a rare disease in adults. It is now termed as neutropenic enterocolitis in adults, because it is seen more often as a complication of aggressive systemic chemotherapy. It is believed to be associated with chemotherapy-induced intestinal mucosal injury followed by a super infection, which leads to bacteremia, and majority of these patient develop neutropenia. They often have vague and nonspecific presentation which gets overshadowed by the symptoms of primary malignant disease and expected toxic side effects of chemotherapy. In this case report, we discuss the case of a middle-aged female with infiltrating ductal carcinoma of breast, who on adjuvant chemotherapy, developed necrotising enterocolitis requiring emergency exploratory laparotomy. The objective of this study is to increase awareness regarding this fatal complication of chemotherapy because very little research has been done so far. We also review literature to find out the cause of necrotising enterocolitis in reported cases. It is recommended to treat diarrhea, caused by chemotherapy, with antibiotics instead of just loperamide because of decreased immunity of the patient, which could lead to fatal complications.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Quimioterapia Adjuvante/efeitos adversos , Enterocolite Necrosante/induzido quimicamente , Adulto , Neoplasias da Mama/cirurgia , Colostomia , Enterocolite Necrosante/cirurgia , Feminino , Humanos
5.
J Coll Physicians Surg Pak ; 28(4): 314-316, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29615176

RESUMO

OBJECTIVE: To find out the 30-day readmission rate for different surgical procedures and determine the causes for readmissions. STUDY DESIGN: An audit report. PLACE AND DURATION OF STUDY: Department of Surgery, The Aga Khan University Hospital, Karachi, in the calendar year 2014. METHODOLOGY: Records were retrospectively reviewed for 30-day readmission rate and their cause in general surgical patients who underwent a general surgical procedure at The Aga Khan University Hospital, Karachi, in the year 2014. RESULTS: Out of 217 (6.4%) readmissions in 3,387 patients, more than 50% unplanned readmissions were avoidable. The highest readmission rate was after placement of feeding tubes (28.5%). CONCLUSION: More than half of the readmissions could have been prevented by proper patient/attendant education, good communication and provision of nursing services to these patients beyond the hospital.


Assuntos
Tempo de Internação/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Cirurgia Geral , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Paquistão/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Qualidade da Assistência à Saúde , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/métodos , Fatores de Tempo
6.
J Coll Physicians Surg Pak ; 28(2): 150-154, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29394976

RESUMO

OBJECTIVE: To find outcomes of emergency bowel surgery and review the processes involved in the care of these patients on the same template used in National Emergency Laparotomy Audit (NELA). STUDY DESIGN: An audit. PLACE AND DURATION OF STUDY: Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 to November 2014. METHODOLOGY: Patients undergone emergency bowel surgery during the review period were included. Demographic data, type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcome was recorded. Data was then compared with the data published by NELA team in their first report. P-value for categorical variables was calculated using Chi-square tests. RESULTS: Although the patients were younger with nearly same spectrum of disease, the mortality rate was significantly more than reported in NELA (24% versus 11%, p=0.004). Comparison showed that care at AKUH was significantly lacking in terms of proper preoperative risk assessment and documentation, case booking to operating room timing, intraoperative goal directed fluid therapy using cardiac output monitoring, postoperative intensive care for highest risk patients and review of elderly patients by MCOP specialist. CONCLUSION: This study helped in understanding the deficiencies in the care of patients undergoing emergency bowel surgery and alarmingly poor outcomes in a very systematic manner. In view of results of this study, it is planned to do interventions in the deficient areas to improve care given to these patients and their outcomes with the limited resources of a developing country.


Assuntos
Emergências , Serviços Médicos de Emergência/normas , Intestinos/cirurgia , Laparotomia/mortalidade , Laparotomia/normas , Auditoria Médica , Adulto , Idoso , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Laparotomia/métodos , Laparotomia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
7.
J Pak Med Assoc ; 66(Suppl 3)(10): S62-S64, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27895357

RESUMO

Immune thrombocytopenia purpura (ITP) may need splenectomy after failure of medical treatment. The aim of this study was to explore the outcome of splenectomy in chronic ITP and to point out factors which can predict better response to splenectomy. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised adult patients who underwent splenectomy for ITP from October 2005 to December 2015. Of the 51 patients, 37(72.5%) were females and 14(27.5%) were males. The overall median age was 32 years (interquartile range: 18-65 years). Complete response was seen in 43(84.3%) patients, 2(4%) had response and 6(11.7%) had no response. Relapse rate of ITP at 1 year was 4(8.8%). Multivariate analysis showed that failure rate of splenectomy in the 41(80.4%) patients aged <50 years was 3(7%) as opposed to 3(30%) in the 10(19.6%) patients aged >50 years (p=0.04). Splenectomy was found to be a safe and effective option for treatment of ITP. Young age at the time of surgery was associated with good response to surgery.


Assuntos
Púrpura Trombocitopênica Idiopática/cirurgia , Esplenectomia , Adolescente , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
J Pak Med Assoc ; 66(1): 90-2, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26712189

RESUMO

INTRODUCTION: CT scan is an important tool in staging of esophageal cancer. Survival can be improved by providing neoadjuvant treatment which depends on stage of esophageal cancer. So it is very important to stage the disease accurately. METHODS: The objective of this study is to determine diagnostic accuracy of CT scan to stage esophageal cancer. Ct scans of 62 patients included in the study were reviewed by a Consultant radiologist who was blinded to the final stage of tumour. Diagnostic accuracy measured by comparing with histopathological staging. RESULTS: Accuracy, sensitivity and specificity of CT for T2 and T3 are 66%, 61%, 68% and 63%, 67%, 56% respectively. Accuracy, sensitivity and specificity of CT for presence of nodal disease are 65%, 59% and 75%. CONCLUSIONS: Ct scan alone has low diagnostic accuracy for staging Esophageal Cancer.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Esofágicas/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Adenocarcinoma/patologia , Adulto , Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/patologia , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
9.
J Pak Med Assoc ; 65(10): 1065-8, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26440834

RESUMO

OBJECTIVE: To evaluate response to neoadjuvant chemoradiation in the treatment of rectal cancer and to see if it can be predicted whether a particular patient will benefit from such treatment. METHODS: The retrospective case series was done at the Aga Khan University Hospital, Karachi, and comprised data related to period from January 2005 to December 2014 of patients with rectal cancer who had received neoadjuvant treatment. They were divided into responders and non-responders on the basis of imaging. Pre-treatment factors were compared to identify differences in the two groups. SPSS 19 was used for statistical analysis. RESULTS: The median age of 35 patients whose records were studied was 44 years (interquartile range: 33-54). Response to neoadjuvant treatment was seen in 13(37%) patients with complete pathological response in 8(22.9%). There was no statistically significant difference in age, gender, pre-treatment tumour stage, tumour biology and distance from anal verge among the responders and the non-responders (p>0.05 each). CONCLUSIONS: Response to neoadjuvant treatment in rectal cancer was low.


Assuntos
Adenocarcinoma/terapia , Terapia Neoadjuvante , Neoplasias Retais/terapia , Adenocarcinoma/patologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão , Neoplasias Retais/patologia , Estudos Retrospectivos , Resultado do Tratamento
10.
J Pak Med Assoc ; 65(2): 223-4, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25842565

RESUMO

We present three cases of young male patients with perforated duodenal ulcer that were diagnosed and treated as appendicitis with appendectomy. They presented with peritonitis and were treated accordingly. Because of the misdiagnosis, their hospital course was significantly prolonged. This morbidity could have been avoided by careful history-taking, examination and per-operative findings.


Assuntos
Apendicite/diagnóstico , Erros de Diagnóstico , Úlcera Duodenal/diagnóstico , Úlcera Péptica Perfurada/diagnóstico , Adulto , Úlcera Duodenal/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Perfurada/etiologia
11.
J Pak Med Assoc ; 64(2): 166-70, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24640806

RESUMO

OBJECTIVE: To determine the factors associated with clinically significant anastomotic leak in patients having undergone large intestinal anastomosis. METHOD: The retrospective study at the Aga Khan University Hospital, Karachi, comprised data between January 2000 and March 2010, related to patients who underwent colorectal anastomosis. Demographic details of the patients, as well as preop, intraop and postop risk factors were recorded. Anastomotic leak was identified as per the defined criteria. Outcome of patients was recorded as postop hospital stay and mortality. Univariate and Multivariate analyses were applied to identify risk factors for anastomotic leakage. RESULTS: Among the total 127 patients in the study, anastomotic leak occurred in 19 (15%) patients (Group 1), while there was no clinical leak in 108 (85%) patients (Group 2). Univariate analysis showed 8 factors to be affecting the anastomotic leak: operation time (p = 0.003), intraoperative blood loss (p = 0.006), intraoperative blood transfusion (p = 0.013), indication of surgery malignancy vs. benign (p = 0.049), type of surgery elective vs. emergency (p = 0.037), intraop use of vasopressor (p = 0.019), segment of bowel anastomosed left side vs. right side (p = 0.012), and drain placement vs. no drain placed (p = 0.035). Preop immunosuppressive therapy was borderline significant (p = 0.089). Multivariate analysis showed that left vs. right sided anastomosis (p = 0.068), blood transfusion > 2 pack cells (p = 0.028), smoker vs. non-smoker (p = 0.049), elective vs. emergency surgery (p = 0.012) were the independent risk factors which significantly affected the outcome of bowel anastomosis. Mortality rate was 15.79% (n = 3/19) in Group 1, while it was 1.85% (n = 2/108) in Group 2 (p = 0.02).The postop hospital stay was 15 +/- 5.44 days in Group 1, while it was 7.51 +/- 4.04 days in Group 2 (p > 0.001). CONCLUSION: In colorectal anastomotic surgeries temporary diversion stoma formation needs to be considered on the basis of risk factors to decrease mortality and morbidity associated with anastomotic leak.


Assuntos
Fístula Anastomótica/etiologia , Colo/cirurgia , Neoplasias Colorretais/cirurgia , Reto/cirurgia , Medição de Risco/métodos , Centros de Atenção Terciária/estatística & dados numéricos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/epidemiologia , Colostomia , Feminino , Seguimentos , Humanos , Incidência , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
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