Background. Laparoscopic cholecystectomy is considered to be gold standard for symptomatic gall stones. As a routine every specimen is sent for histopathological examination postoperatively. Incidentally finding gall bladder cancers in those specimens is around 0.5–1.1%. The aim of this study is to identify those preoperative and intraoperative factors in patients with incidental gall bladder cancer to reduce unnecessary work load on pathologist and cost of investigation particularly in a developing world. Methods. Retrospective records were analyzed from January 2005 to February 2015 in a surgical unit. Demographic data, preoperative imaging, peroperative findings, macroscopic appearance, and histopathological findings were noted. Gall bladder wall was considered to be thickened if ≥3 mm on preoperative imaging or surgeons comment (on operative findings) and histopathology report. AJCC TNM system was used to stage gall bladder cancer. Results. 973 patients underwent cholecystectomy for symptomatic gallstone disease. Gallbladder carcinoma was incidentally found in 11 cases. Macroscopic abnormalities of the gallbladder were found in all those 11 patients. In patients with a macroscopically normal gallbladder, there were no cases of gallbladder carcinoma. Conclusion. Preoperative and operative findings play a pivotal role in determining incidental chances of gall bladder malignancy.
Background and Objectives. Preoperative counseling is effective to foster early postoperative mobilization that reduces pulmonary complications following abdominal surgery. This study aims at evaluating the effect of preoperative counseling regarding postoperative mobilization and its impact on reducing pulmonary complications. Design and Setting. Randomized control trial was conducted at the Department of Surgery of a tertiary care hospital, Karachi. Patients and Materials. Patients who underwent abdominal surgery and met inclusion criteria were recruited. All participants were randomly divided into two groups. Both groups received information about the surgery and Group I received additional counseling for postoperative mobilization. All patients were encouraged for postoperative mobilization. Scholes et al. criteria were used to evaluate postoperative pulmonary complications. Results. In total 232 participants were recruited and divided into two groups. There was no significant difference in participants' age (P = 0.79), duration of surgery (P = 0.5), and pain score (P = 0.1) of both groups. However, significant difference was identified in mobilization from bed to chair and mobilization for >10 minutes. Patients in Group I experienced less pulmonary complications in comparison with Group II.
Endodontic procedures rely heavily on correct radiographs. All stages of endodontic care delivery are affected by the quality of resultant image. Objective of this study was to observe type and frequency of technical errors reported during obtaining intraoral radiographs in the endodontic Department of a teaching hospital. METHODOLOGY: A total of 600 radiographs were included in this retrospective audit. The radiographs were exposed during routine endodontic procedures. A previously published criteria was used to ascertain the technical quality. SPSS version 21 for windows was used for statistical analysis. Frequency and percentage was calculated as well as chi square test was used to determine associations between variables. P < 0.05 was considered significant. RESULTS: A total of 600 radiographs were included in our study out of which, 185 (30.8%) were found to be technically correct (p=0.183). Radiographs of mandibular molars presented with most errors (n=115, 42.4%, p=0.002). Errors of technique were more prevalent (n=383, 63.8%) followed by errors of processing (n=151, 25.2%, p=0.000). Most common error of technique was positioning error (n=113, 18.8%) (Table no 3). Most common processing error was yellowing of radiographs (n=60, 10%, p=0.003). CONCLUSION: Performance of undergraduate students in obtaining radiographs was poor. Positioning errors were found to be the most common error while radiographs of mandibular molars were most affected.
Background. There has been argument between clinical practitioners about clamping catheter or not prior to its removal after transurethral resection of prostate (TURP). We conducted a clinical trial to assess whether clamping has any role in early bladder tone recovery particularly in patients who undergo TURP. Methods. Randomized clinical trial was conducted at a tertiary care hospital, Karachi from January 2014 to July 2015. Eighty-six study participants who underwent TURP were randomly allocated into two groups of 43 participants each. In Group I, patient's Foley catheter was not clamped prior to its removal and in Group II Foley catheter was clamped. Data of all subjects were analyzed using SPSS version 20. Results. There was no significant difference in age and weight of resected tissues between two groups. Among 4 patients in Group I who required recatheterization, 1 patient was discharged with catheter as compared to Group II in which 2 patients were discharged with catheter (P = 0.99). Only 1 patient (2.3%) in Group II had bleeding which required recatheterization. Length of stay was significantly affected by early and free removal of Foley catheter (P < 0.001). Conclusion. The results of current study identified that clamping whether done or not had no significant impact on urinary retention.
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