Laparoscopic cholecystectomy in acute gall bladder

To look for the feasibility and results of laparoscopic cholecystectomy in acutely inflamed gall bladder, gangrenous cholecystitis and empyema gall bladder. It was a prospective observational case series. As an institutional policy early laparoscopic cholecystectomy was performed in all the patients with diagnosis of acute cholecystitis. The incidence of gangrenous cholecystitis and empyema gall bladder was noted and laparoscopic intervention was preferred in all these patients. The demographic profile, clinical records, operative details, complications and follow up details were prospectively gathered on a performa. Early laparoscopic cholecystectomy was performed in 142 patients. 103 patients had simple acute cholecystitis, 13 patients had empyema gall bladder and 26 patients had gangrenous cholecystitis. The incidence of comorbids such as diabetes mellitus, hypertension and ischemia heart diseases was 28.1%, 61.5 and 80.75 in patients with simple acute cholecystitis, empyema gall bladder and gangrenous cholecystitis respectively. Male gender was predominating in patients with complicated cholecystitis. The open conversion rate was 3.88% in simple acute cholecystitis, 15.38% in empyema gall bladder and gangrenous cholecystitis combined. There were 2 major complications in patients with simple acute cholecystitis and 2 major complications in patients with gangrenous cholecystitis. There was one mortality in a patient with simple acute cholecystitis. Laparoscopic cholecystectomy is a safe and effective option in acute gall bladder. Based on our experience we recommend an early laparoscopic gall bladder removal, provided expertise and gadgets are available

effects of CO2 pneumoperitoneum on end tidal CO[2] [ETCO[2]], arterial blood pressure and heart rate during laparoscopic cholecystectomy under general anaesthesia

To analyze the effects of CO2 pneumoperitoneum at 13 to 15 mmHg infra-abdominal pressure on end tidal CO2 [ETCO2], arterial blood pressure and heart rate during laparoscopic cholecystectomy under general anaesthesia with controlled mechanical ventilation. Prospective Descriptive Study. The study was conducted at the department of anaesthesia Fauji Foundation Hospital Rawalpindi from August 2005 to September 2006. Fifty consecutive ASA grade-1 patients, 47 females, 3 males and aged 35-65 years undergoing laparoscopic cholecystectomy were included in the study. All patients received a standardized balanced anaesthetic in which 0.7 - 1% isoflurane was used during maintenance. Ventilation was controlled and minute volume was kept at 100 ml/kg/min. Pneumoperitoneum was created with CO2 at a flow rate of 10 liter/min and 13 to 15 mmHg infra abdominal pressure was maintained during the operation. End tidal CO2 [ETCO2], heart rate and non invasive systolic, diastolic and mean arterial blood pressure was recorded immediately before infra abdominal C02 insufflation and then after 5 minutes interval during the period of CO2 pneumoperitoneum. Study period started immediately before infra-abdominal CO2 insufflation till about 60 minutes of surgical procedure. The end tidal CO2 [ETCO2] levels progressively increased to reach a plateau 36mmHg 20 minutes after the beginning of infra abdominal CO2 insufflation. The end tidal CO2 [ETCO2] levels increased to 21% of base line [from 30 to 36 mmHg] during CO2 pneumoperitoneum for laparoscopic cholecystectomy under controlled mechanical ventilation at minute volume 100 ml/kg/min. The systolic, diastolic and mean arterial blood pressure increased to 12% to 17% of the baseline during CO2 pneumoperitoneum at 13-15 mmHg infra abdominal pressure. There was no significant change in heart rate. CO2 pneumoperitoneum produces rise in end tidal CO2 [ETCO2] levels and hemodynamic alterations proportional to the increased infra abdominal pressure during laparoscopic surgery under general anaesthesia with controlled mechanical ventilation

Nosocomial uropathogens and their antibiotic sensitivity patterns in a tertiary referral teaching hospital in Rawalpindi, Pakistan

Nosocomial urinary tract infections [NUTIs] are by definition not present at admission of a patient and are acquired during hospitalisation. The objective of this study was to study the uropathogens and their antibiotic sensitivity patterns in hospital acquired urinary tract infections presenting in a teaching hospital. It was a retrospective descriptive study carried out at the Department of Pathology, Fauji Foundation Hospital, Rawalpindi, Pakistan, during the year 2009. Reports of urine culture and sensitivity performed during one year were retrospectively studied with a view to document various isolates and their antimicrobial sensitivity. Out of a total number of 1204 urine cultures submitted, 246 were found to have nosocomial urinary tract infections. Over all prevalence of nosocomial urinary tract infection in the examined reports was 20.43%. Nosocomial Urinary tract infections are common. Gram negative bacilli are most frequent uropathogens and are resistant to commonly used antibiotics. Fosfomycin followed by Gentamycin and Cefotaxime were the most effective antibiotics

Role of diagnostic laparoscopy: a study of 58 patients

To evaluate the role of diagnostic laparoscopy in undiagnosed abdominal diseases. Prospective nonrandomized descriptive study. Fauji Foundation Hospital Rawalpindi, from l[st] January 2007 till 31[st] December, 2009. All the patients of undiagnosed intermittent or chronic pain abdomen and other pathologies presenting to the department of surgery who were candidates for laparoscopy were included in the study. Total of 58 patients [42 females and 16 males] were included in the study. Appendicular pathology, abdominal tuberculosis and pelvic inflammatory disease each was found in 8 patients [13.79%] and adhesions in 6 patients [10.33%]. Other less common pathologies included undescended intraabdominal testes, endometriosis, gall bladder pathology and mesenteric lymphadenopathy. In 14 patients [24.13%] no pathology was detected. Diagnostic laparoscopy is an important diagnostic tool in the armamentarium of surgeons which can be employed for diagnosis of obscure abdominal conditions. Where appropriate therapeutic measures if indicated can be adopted at the same time

Comparative study of inverting sutureline versus over and over continuous suturing in hypospadias repair

Hypospadias is one of the most common congenital anomalies of the male newborns affecting 1 in 300. Urethral meatus lies ectopically on the ventral surface of penis proximal to its normal position. There is defective development of urethral spongiosum and ventral prepuce. Various degrees of chordee may be associated. Objective of the study was to study the incidence of urethrocutaneous fistula formation after hypospadias repair employing two different suturing techniques. This Prospective Randomised Descriptive Clinical Trial was conducted in Department of Surgery, Fauji Foundation Hospital, Rawalpindi and Basharat Hospital, Rawalpindi, during a period of five years from January 2005 till December, 2009. A prospective study of 100 patients of glanular/penile hypospadias requiring repair was completed from January, 2005 till December, 2009. Fifty of these patients had urethral tube reconstruction using conventional over and over continuous suturing technique [Group-1]. In another group of fifty patients continuous inverting sutures [Connel technique] commonly used in intestinal anastomosis was employed [Group-2]. Polyglycolic acid sutures 4/0 to 6/0 as appropriate were used for all the repairs in both the groups by the same surgeon. Six [12%] urethrocutaneous fistulas formed in the Group-1 of fifty patients with over and over continuous suturing as compared to 4 [8%] in Group- II with equal number of patients where inverting suture technique was used. Inverting sutures reduce the incidence of urethrocutaneous fistula formation in hypospadias repair

Prevalence of malignancy in goitre-a review of 718 thyroidectomies

Thyroid malignancies are a heterogeneous group of tumours which show considerable variability in biological behaviour, histological appearances and response to therapy. Thyroid cancer is uncommon and represents only 1% of all malignancies. Objective was to determine the prevalence of malignancy in patients presenting with goitre. This prospective, observational study was conducted at Department of Surgery, Fauji Foundation Hospital, Rawalpindi from January 1999 to December 2008. All patients requiring surgery for goitre were included in the study. Postoperatively histopathologies of specimens were evaluated in all patients. 718 patients were operated and post operative histopathology specimens were reviewed. 2.92% of patients were found to have malignancy. Prevalence of papillary and follicular carcinoma was 33.33% each. Anaplastic carcinoma was found in 23.81% of patients followed by Hurthle cell carcinoma in 9.53% of patients. All postoperative thyroid specimens should be subjected to histopathology. Prevalence of follicular carcinoma and anaplastic carcinoma is relatively higher in our country due to high incidence of iodine deficiency goitre

Rupture splenic artery aneurysm

We present a case of ruptured splenic artery aneurysm in 18 years old unmarried girl who presented with severe upper abdominal pain and sudden collapse. Ultrasound abdomen showed free fluid and ultrasound guided needle aspiration confirmed haemoperitoneum. On laparotomy, a 3cm saccular aneurysm of the middle of the splenic artery was noted. With prompt and urgent management the patient survived