950 Experience of Inguinal Mesh Hernioplasty Under Local Anaesthesia: A 3-Year Experience in A Teaching Hospital

Objective

To prove Inguinal mesh hernioplasty under L/A is safe and acceptable. Helps with post-operative pain and enables rapid recovery as a day case.

Method

All patients who underwent inguinal hernia repair under local anaesthesia were retrospectively analysed in our hospital between July 2014- July 2017. Clinical judgement was used for inclusion and exclusion parameters.

Results

From July 2014- July 2017, 260 patients were included in study who underwent Inguinal mesh hernioplasty under L/A. ASA grade for all patients ranged between I-III. The mean age was 37 (20-65). Intraoperatively (9.1) 3.5% patients had problems such as pain, hypotension or sweating. About (86.3%) 224 patients were discharged home the same day and remaining stayed overnight for less than 24 hours. Hematoma was seen in 5 (1.92%) patients, Urinary retention in 2 (0.7%) patients, Wound infection seen in 24(9.2%) patients, Readmission in 10 (3.8%) patients. Chronic groin pain was seen in 10 (3.9%) patients and no recurrence on 6 months follow up.

Conclusions

Our results showed that this procedure is feasible under L/A and can be performed safely. It showed satisfactory acceptance by the operating surgeon and patient, without significant perioperative issues. It is reliable and showed shorter hospital stay.

975 Outcome of Low Verus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy: A Randomized Trial

Introduction

Recent studies have shown that patients may experience considerable pain after laparoscopic cholecystectomy as well. Hence, this study was done to compare results on post op pain with low pressure pneumoperitoneum compared with standard pneumoperitoneum.

Method

100 patients were selected for study and equally divided in two groups randomized into Low pressure (n = 50) and Standard pressure (n = 50). Operative time (min), postoperative pain (VAS) and frequency of Shoulder Tip Pain was noted in both groups

Results

A total of 100 patients were enrolled for this study. Patients were divided into two groups i.e. Group-A (Standard pressure) and Group-B (Low pressure). In group-A, there were 35(70%) males and 15(30%) females, while in group-B, there were 41(82%) males and 9(18%) females. Mean age of group-A patients was 42.0±7.0 years and 44.5±8.1 years in group-B. In group-A, 18(36%) patients had shoulder tip pain, while 4(8%) patients had had shoulder tip pain in group-B patients with a p-value of 0.001, which is statistically significant.

Conclusions

Laparoscopic cholecystectomy using low pressure pneumoperitoneum is feasible and results in less post-operative shoulder tip pain.

957 Comparison of Inguinodynia In Patients Undergoing Prophylactic Ilioinguinal Neurectomy vs No Neurectomy In Lichtenstein Mesh Hernioplasty

Objective

The objective of this study is to compare the frequency of inguinodynia in ilioinguinal neurectomy VS no neurectomy in patients undergoing Lichtenstein mesh hernioplasty.

Method

200 male patients with unilateral, primary, reducible inguinal hernia were randomly distributed in to two groups by using lottery method to undergo Lichtenstein’s hernia repair i.e., with and without ilioinguinal neurectomy. All the operation were carried out under local anesthesia. Pain score was calculated using the VAS system at 3rd month and inguinodynia was labelled if it is more than 1 on VAS scale.

Results

200 male patients with mean age of 53.25 ± 6.768 were included. 42 (21%) had Inguinodynia after surgery. When we cross tabulated both groups with inguinodynia, results came up significant (p = 0.001). In neurectomy group 10 patients had inguinodynia while in no neurectomy group, 32 patients were having Inguinodynia. There was no effect of malnutrition on outcome. Younger age group benefitted more from procedure.

Conclusions

It is concluded that there is difference in frequency of inguinodynia in ilioinguinal neurectomy versus no neurectomy in patients undergoing Lichtenstein hernia repair. Patients with ilioinguinal neurectomy had reduced incidence of inguinodynia.

Seroepidemiological survey on Rift Valley fever among small ruminants and their close human contacts in Makkah, Saudi Arabia, in 2011

This study describes a seroepidemiological survey on Rift Valley fever (RVF) among small ruminants and their close human contacts in Makkah, Saudi Arabia. A total of 500 small ruminants (126 local, 374 imported) were randomly selected from the sacrifice livestock yards of Al-Kaakiah slaughterhouse, in the holy city of Makkah, during the pilgrimage season 1432 H (4-9 November 2011). In addition, blood samples were collected from 100 local workers in close contact with the animals at the slaughterhouse. An RVF competition multi-species enzyme-linked immunosorbent assay (ELISA) detecting anti-RVF virus immunoglobulin G (IgG)/ immunoglobulin M (IgM) antibodies and an RVF IgM-specific ELISA were used for serological investigations. In total, 84 (16.8%) of the 500 sacrificial sheep and goats tested seropositive in the competition ELISA but no IgM antibodies were detected in the IgM-specific assay. All seropositive samples, comprising 17.91% of the imported animals and 13.49% of the local ones, were therefore designated positive for anti-RVF virus IgG antibody. Among the local personnel working in close contact with the animals, 9% tested seropositive in the RVF competition ELISA. The study indicates that two factors may increase the likelihood of an RVF outbreak among sacrificial animals and pilgrims: i) the large-scale importation of small ruminants into Saudi Arabia from the Horn of Africa shortly before the pilgrimage season, and ii) the movement of animals within Saudi Arabia, from the RVF-endemic south-western area (Jizan region) to the Makkah region, particularly in the few weeks before the pilgrimage season. From these findings, it is recommended that i) all regulations concerning the import of animals into Saudi Arabia from Africa should be rigorously applied, particularly the RVF vaccination of all ruminants destined for export at least two weeks before exportation, and ii) the movement of animals from the RVF-endemic south-western area (Jizan region) of Saudi Arabia to the Makkah region should be strictly prohibited.

A statistical evaluation of common cancer trends and cancer occurrence by age group in the population of Lahore, Pakistan, 1984-2011

BACKGROUND

Due to the unavailability of a common cancer incidence database in Pakistan, the cancer incidence data from nuclear medicine and oncology institutes have been gathered and presented.

METHODS

The cancer incidence data for the last 27 years (1984-2011) is included to present a data set of male and female patients. The data analysis concerning occurrence, trends of common cancers in male and female patients, stage-wise distribution, and mortality/follow-up cases is also incorporated for the last 7 years (2004-2011).

RESULTS AND CONCLUSIONS

The cancer incidence rates for head and neck (13.41 percent), brain tumors (10.90 percent), and non-Hodgkin lymphoma (NHL, 9.70 percent) were found to be the highest in male patients, whereas breast cancer (45 percent), ovary tumors (6.6 percent), and head and neck (6.21 percent) cancer incidence rates were observed to be the most common in female patients. The age range distribution of diagnosed and treated patients in conjunction with the percentage contribution of cancer-treated patients from different cities of Punjab at the Institute of Nuclear Medicine and Oncology, Lahore is also included. Leukemia has been found the most common cancer for the age group of 1-12 years. It has been identified that the maximum number of diagnosed cases were found in the age range of 51-60 years for male and 41-50 years for female cancer patients.

High-risk sexual behaviours among drug users in Pakistan: implications for prevention of STDs and HIV/AIDS

Our objective was to describe HIV/STD risk behaviours and awareness among a community-based sample of drug users in Pakistan. Drug users contacted through street outreach by a non-governmental organization in Quetta, Peshawar and Rawalpindi underwent interviewer-administered questionnaires. Descriptive statistics were used to characterize sexual behaviours by city, marital status and the use of injection drugs. Logistic regression was used to identify correlates of ever having an STD. Of 608 drug users studied, all but one was male; median age was 32 years and 45% had no formal education. Half were married, of whom 25% were living with their wives. Sexual behaviours were reported as follows: 14% had sex with other males, 28% reported sex with males and females, 49% had paid money to have sex and only 10% had ever used condoms. One-fifth reported having had an STD and about 40% reported having suffered from either one or more STD-related symptoms. Only 41% had heard about HIV/AIDS, of whom 17% knew that HIV/AIDS could be transmitted through sexual contact. In conclusion, high-risk sexual behaviours are prevalent among male drug users in Pakistan, and awareness of transmission risks is low. These data attest to the urgent need for effective and specific interventions in Pakistan to prevent transmission of HIV and STDs among drug users and their sex partners (I J STD & AIDS 2004;15:601-7).

High-risk sexual behaviours among drug users in Pakistan: implications for prevention of STDs and HIV/AIDS

Our objective was to describe HIV/STD risk behaviours and awareness among a community-based sample of drug users in Pakistan. Drug users contacted through street outreach by a non-governmental organization in Quetta, Peshawar and Rawalpindi underwent interviewer-administered questionnaires. Descriptive statistics were used to characterize sexual behaviours by city, marital status and the use of injection drugs. Logistic regression was used to identify correlates of ever having an STD. Of 608 drug users studied, all but one was male; median age was 32 years and 45% had no formal education. Half were married, of whom 25% were living with their wives. Sexual behaviours were reported as follows: 14% had sex with other males, 28% reported sex with both males and females, 49% had paid money to have sex and only 10% had ever used condoms. One-fifth reported having had an STD and about 40% reported having suffered from either one or more STD-related symptoms. Only 41% had heard about HIV/AIDS, of whom 17% knew that HIV/AIDS could be transmitted through sexual contact. In conclusion, high-risk sexual behaviours are prevalent among male drug users in Pakistan, and awareness of transmission risks is low. These data attest to the urgent need for effective and specific interventions in Pakistan to prevent transmission of HIV and STDs among drug users and their sex partners.

The hypomagnesaemic action of FK506: urinary excretion of magnesium and calcium and the role of parathyroid hormone

A side-effect of the immunosuppressive drug FK506 (Prograf; tacrolimus) is hypomagnesaemia. We have investigated the effects of short-term (7-day) treatment of rats with FK506, using a protocol designed to indicate whether there are modifications in the renal tubular handling of magnesium and other electrolytes, or in the tissue deposition of magnesium, which may account for the hypomagnesaemia. We have also investigated whether parathyroid hormone has a role in the observed hypomagnesaemia. Two studies have been performed; in the first we administered FK506 (0.5 mg x kg(-1) body weight x day(-1)) or vehicle by intraperitoneal injection for 7 days, and then housed the rats in metabolic cages for the 24 h collection of urine. At the end of the metabolic cage period, the animals were anaesthetized, and blood and tissue samples were taken for analysis. In the second set of experiments the dosage regime was identical, but at the end of the treatment period the animals were anaesthetized for implantation of arterial and venous cannulae, and then received a saline (plus inulin) infusion for 6 h, during which time blood and urine samples were collected. The dose of FK506 employed did not decrease the glomerular filtration rate. FK506 elicited hypomagnesaemia in both sets of experiments, accompanied by inappropriately high fractional excretion of magnesium. There was also evidence of disruption of the normal renal reabsorption of calcium, but this did not result in hypocalcaemia. Plasma parathyroid hormone activity was not significantly different between the two groups, and there was no evidence of altered tissue content of magnesium in kidney, liver, heart, skeletal muscle or bone. The study confirms that hypomagnesaemia is a significant side-effect of FK506, even at a relatively low dose which did not decrease the glomerular filtration rate. The effect is not due to a decrease in parathyroid hormone release, or to translocation of magnesium from plasma to tissues, but does reflect decreased renal tubular magnesium (and calcium) reabsorption.

Prenatal diagnosis of haemophilia-A: a basis for the Pakistani families

OBJECTIVE

To determine the feasibility of a PCR based strategy for prenatal diagnosis of Haemophilia-A in Pakistani Families.

DESIGN

Prospective.

SETTING

Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi.

SUBJECTS

Five families with at least one child affected with Haemophilia-A. Each family comprised of father, mother, affected child and fetus when present.

MAIN OUTCOME MEASURES

Short Tandem Repeat (STR) analysis in the Intron 22 of factor VIII gene.

RESULTS

PCR based analysis of the STR in intron 22 of factor VIII gene showed that the marker was informative in 4/5 study families and could be used in these families for the prenatal diagnosis of Haemophilia-A. In two families prenatal diagnosis was carried out by Chorionic Villus Sampling at 10-13 weeks gestation and the results in both the cases showed a carrier female fetus.

CONCLUSION

Linkage based prenatal diagnosis of Haemophilia-A by an intragenic STR marker is feasible in most of the Pakistani families. The long term response of the Haemophiliac families to the availability of prenatal diagnosis remains to be seen. The STR marker can also be used for carrier detection of female subjects in the affected families.

Acquired amegakaryocytic thrombocytopenic purpura (AATP): a hospital based study

OBJECTIVE

To determine the frequency of Acquired Amegakaryocytic Thrombocytopenic Purpura (AATT), possible aetiology, course and prognosis.

DESIGN

Retrospectively diagnosed patients, treated and followed prospectively.

SETTING

Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi.

SUBJECTS

One hundred twenty patients with thrombocytopenic purpura.

MAIN OUTCOME MEASURES

Response to treatment and course of disease.

RESULTS

Out of 22 patients 2 died of cerebral haemorrhage, one transformed to Myelodysplastic Syndrome (MDS), one transformed to Acute Myeloid Levkaenia (AML). None is transfusion independent.

CONCLUSION

AATT is not an infrequent disorder. It shows poor response to all available therapeutic modalities and has a potential for transformation into Myelodysplasia and acute myeloid leukaemia.

Ketamine for bone marrow aspiration and trephine biopsy in children

To make bone marrow aspiration and trephine biopsy less painful and more acceptable in children a short acting anaesthetic ketamine was used in a dose of 1-2 mg/kg body weight intravenously or 4-5 mg/kg intramuscularly. One hundred cases aged 2 to 13 years were studied. The actual procedure time ranged between 20 seconds and 3 minutes, adequate samples were obtained in 80% of children on first attempt. Vomiting was the only side effect noted in two children. Ketamine is safe and recommended in all children undergoing bone marrow aspiration and trephine biopsies.

Bone marrow involvement in Hodgkin's disease: the significance of non-infiltrative changes

We have tried to elucidate the significance of so called non-infiltrative changes in order to find their place in the staging procedure particularly in countries where facilities for elaborate clinical staging are not available. Seventy nine out of 88 patients were classified into 3 groups depending upon the histological findings in their bone marrow trephine biopsies. Bone marrow in Group-I (n = 20) patients was essentially normal. The established criteria of bone marrow involvement were fulfilled in Group III patients (n = 25); while bone marrow in Group-II patients (n = 34) showed non-infiltrative changes. The clinical presentation, peripheral blood parameters and LDH levels of the 3 groups of patients were compared. There was progressive anaemia, neutrophilic leucocytosis and increase in ESR from Group I to III. The change was statistically significant when Group I was compared with Group II or Group III but non-significant when Group II was compared with Group III. It is, therefore, postulated that both Groups II and III reflect the bone marrow involvement although the changes observed in Group II do not satisfy the previously established criteria for this purpose.

Laryngeal amyloidosis: clinicopathologic study of seven cases

The larynx is usually involved with amyloid as an isolated phenomenon and infrequently in generalized amyloidosis. This study includes six females and one male with an average age of 54 years who complained chiefly of prolonged hoarseness. At direct laryngoscopy, the amyloid usually presented as firm, nonulcerated yellow, red, or white lesions most often involving the ventricle, true and false cords. Surgical biopsy and/or excision was the only form of treatment. One patient experienced recurrence of her amyloid seven years after her first operation while another patient developed extralaryngeal amyloid. Amyloid is deposited extracellularly as amorphous eosinophilic material in vascular walls and basement membranes of minor salivary glands, as random tissue masses, or as "rings" in adipose tissue. Under the electron microscope, all types of amyloid have the same basic structure. However, chemical analysis has revealed three different classes of amyloid: amyloid of immunoglobulin origin, amyloid of unknown origin, and apudamyloid. Evidence suggests an immunoglobulin origin of at least some cases of amyloid localized to the larynx. It is theorized that the secretions of a monoclonal plasmacytic infiltrate of the larynx are metabolized into immunoglobulin light chain fragments by adjacent histiocytes and deposited extracellularly as amyloid.