Management of polypoid lesions of the gall bladder

To analyze the demographic and clinical characteristics of patients diagnosed with polypoidal lesions of gall bladder and to correlate the radiological and histopathological diagnosis. Descriptive study. At Hamdard University Hospital Karachi over a period of 9 years [July 1999- June 2008]. The study included all those patients who were operated for gall bladder polyps. Patients of both sexes above14 years of age diagnosed on the basis of ultrasound and underwent cholecystectomy were included in the study. Twenty eight patients were included in this study with male to female ratio of approximately 1:8. Mean age of patients was 47.5 years. Twenty five patients were having symptomatic gall bladder disease. On the basis of ultrasound 19 patients had solitary polyp while 9 had multiple lesions. All these patients were operated laparoscopically; only one patient had a conversion to open cholecystectomy. Out of total 28 patients 19 were histopathologically proven benign polyps, one patient had severely dysplastic polypoidal lesion while eight patients had chronic cholecystitis with prominent folds with or without gall stones. Of 19 patients with benign disease 15 had cholesterol polyps and remaining 4 had adenomas. Gall bladder polyps are important cause of symptomatic gall bladder disease with peak incidence in 4th to 5th decade. Most of the gall bladder polyps are benign with cholesterol polyps and adenomas being the commonest lesions found on histopathology. Ultrasonography is good diagnostic tool with reasonable accuracy

Post-cholecystectomy biliary injuries: diagnosis and management

To evaluate the management strategies following Bile Duct Injuries. Retrospective and prospective analysis from July 2002 to Oct. 2005. Surgical Ward-2, Jinnah Postgraduate Medical Centre, Karachi. All patients who were admitted with Iatrogenic Biliary injuries. The patients were clarked and their clinical features noted. After appropriate preparations they were treated on the basis of Bismuth Classification. A total of 21 patients presented with Iatrogenic Biliary injuries over a period of three years. There were 15 females and six males with a median age of 40 years. Fourteen patients had laparoscopic cholecystectomy while seven had open cholecystectomy. Six cases belonged to our unit while 15 were referred from other institutes. Sixteen patients presented with biliary leak, out of which two resolved, two had ultrasound guided aspiration and two ERCP stenting done, while 10 underwent peritoneal lavage with drain placement. One patient from lavage group required ERCP stenting while one patient that underwent stenting initially developed stricture and had to undergo Roux-en-Y hepaticojejunostomy. Five patients had biliary stricture at presentation, three were Bismuth Type I, one was Type III and one Type IV. These patients were treated with Roux-en-Y hepaticojejunostomy. Two had to undergo re-exploration, one needed lavage and the other revision hepaticojejunostomy. Three patients expired in the early postoperative period. Strategies need to be developed for dealing with bile duct injuries, with a view to reduce morbidity and mortality as early recognition and timely management improves the outcome of these patients

Nitroglycerine ointment for anal fissure

To determine long term effectiveness of glyceryl trinitrate [GTN] for treatment of anal fissure and to find out its side effects. This study was done on patients who presented with symptoms of anal fissure in colorectal clinic surgical ward 2 JPMC. Total 498 patients were included out of which 237 had acute anal fissure while 261 patients had chronic fissure. All patients received 8 weeks treatment with 0.2% GTN ointment three times daily applied over perianal area. Those patients who developed side effects i.e. headache were offered treatment with 2% diltiazem. After 8 weeks treatment 228 patients of acute anal fissure had complete healing and 9 patients had partial response. In chronic anal fissure, 229 patients completely healed after 8 weeks of treatment while 32 patients were advised further 4 weeks treatment of GTN due to partial healing and out of them 22 patients had complete healing. Thirteen patients had to undergo lateral sphincterotomy. Five patients complained of headache that settled after shifting to treatment with diltiazem ointment. Ten patients developed recurrence of symptoms. GTN proved to be good first line treatment for most of patients with anal fissure. Small group of patients experience recurrence of symptoms and most of them respond to prolong duration of treatment

Comparison of preoperative ultrasonographic findings with operative finding in hepatobiliary surgery

To compare preoperative ultrasonographic findings with operative findings in hepatobiliary surgery. Design and Place of study: A descriptive study was conduced at Unit II, Dept. of Surgery, CHK. Place and Duration: The study was conducted in Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Centre, Karachi, Pakistan between February, 2000 to January, 2004. Patient And Hundred patients admitted over a period of two years from January, 2002 to December 2003, for hepatobiliary diseases were included in the study. Ultrasonography for their basic problem was done. All these patients underwent surgery. Operative findings were compared with preoperative ultrasonography findings and the accuracy of ultrasonography in hepatobiliary diseases was evaluated. In 34 cases, ultrasonographic findings as compared to operative findings were inaccurate while in 55 patients these were comparable to operative findings. Generally accepted overall accuracy rate of ultrasonography in hepatobiliary diseases is 86%. Accuracy rate in this study was only 66% showing that ultrasonography is an operator dependant procedure