Differences in Surgical Outcome in Near Total Thyroidectomy for Benign Nodular Goiter: A Comparison of LigaSure Vessel Sealer versus Conventional Clamp Knot Tie Technique

Objective: To compare the efficacy of LigaSure Vessel Sealer in Near Total Thyroidectomy versus Conventional Clamp Knot Tie Technique in terms of bleeding, operative time and postoperative drainage.&#x0D; Methodology: This comparative cross sectional study was conducted at Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro. Study duration was one year from November 2019 to October 2020. All patients of any age with benign multinodular goiter and either of gender were included. The study subjects were grouped into two categories by randomization (odd / even). The odd numbers were given to patients operated for ligasure and even numbers were given to patients operated with conventional clamp knot tie technique.  Outcomes were observed with respect to post-operative calcium level, intra-operative bleeding, operative time, post-operative pain &amp; post-operative hospital stay. All the data was recorded via study proforma. Data was analyzed by using SPSS version 20.&#x0D; Results: Total 55 patients were observed. Mean age was 33.25±10.60 years in clamp knot tie procedure group and 35.16±07.96 years in ligasure technique group; without significant difference (p-0.448). Pre and post-operative calcium levels were statistically insignificant among both groups (p-0.358 and 0.163), while loss of blood, hospital stay, post-operative pain and operative duration were significantly greater in clamp knot tie technique group in comparison to ligasure technique group (p-&lt;0.001).&#x0D; Conclusion: LigaSure Vessel Sealer is a feasible and reliable surgical technique and significantly more effective as compared to conventional clamp knot tie technique in terms of post-operative bleeding, operative time, post-operative pain and post-operative hospital stay. However, calcium level was statistically insignificant.</jats:p

Clinical Presentation and Different Treatment Modalities of Obstructed Jaundice

Objective: To determine the clinical presentation and different treatment modalities of obstructed jaundice at tertiary care Hospital.&#x0D; Study Design: Prospective observational study.&#x0D; Place and Duration: Present study was conducted in the Department of general Surgery of Liaquat University of Medical and Health Sciences, Jamshoro during two years from July 2015 to June 2017.&#x0D; Patients and Methods: Total 50 patients having obstructed jaundice and either gender were evaluated after taking history, clinical examinations including specific investigations like ultrasound of abdomen, liver function test (LFT), magnetic resonance cholangiopancreatography (MRCP), computed tomography (CT) endoscopic retrograde cholangio pancreatography (ERCP), magnetic resonance imaging (MRI), percutaneous transhepatic cholangiography (PTC) biopsy, tumor markers and x- ray chest for diagnosis and prognosis purpose. All the data was recorded via self-made proforma.                                                   &#x0D; Results: Out of all cases, 20 patients were in age group of 30 to 45 year, 21 patients were in age group 46 to 64 years and 09 patients were in age group 65 to 80 year. Thirty one patients were presented with intermittent jaundice and pain,14 patients had jaundice, pruritus, pale stool, dark urine and 5 patients were presented with jaundice, pruritus, pale stool with dark urine, pain, anorexia and weight loss. Thirty one patients were diagnosed with benign lesions and 19 patients had malignant lesions. Most of the patients (26.52%) were treated by ERCP, stent. Fifteen underwent open surgery, and 9 were treated by palliative procedure, chemotherapy, radiotherapy and gene therapy.&#x0D; Conclusion: Obstructed jaundice is a critical problem all over the world, in which initially patients present with jaundice, pain, pruritus with pale stool, dark urine and weight loss. Patients can be treated by ERCP, stent. Fifteen patients underwent open surgery and 9 were treated by palliative procedure, chemotherapy, radiotherapy and gene therapy.</jats:p

LAPAROSCOPIC CHOLECYSTECTOMY

With surgeon’s growing experience and advancement of technology laparoscopiccholecystectomy has gone thru many modifications including reduction in number and size ofports. Midline three port laparoscopic cholecystectomy is not performed extensively and istechnically possible. Aim of our study is to see outcome of midline three port laparoscopiccholecystectomy. Study Design: Descriptive study. Period: January 2013 to December 2013.Setting: Surgical unit I, Liaquat University Hospital Jamshoro. Materials and Methods: Midlinethree port laparoscopic cholecystectomy was performed in 75 patients. Outcome of procedureincluded patient’s safety, procedure’s duration, quantitative analgesic requirement, postoperativepain assessed on 10cm visual analog scale after 24 hours, post-operative hospitalstay and post-operative complications. Results: Total of 75 patients underwent midline threeport LC with majority of females 84%. Mean age being43.62±6.85 years. Mean operative timewas 41.30±6.38 minutes. Mean post-operative pain assessed on visual analog scale after24 hours was 2.5±0.45. Maximum site of tenderness was at 10mm subxiphisternal port. 47patients (62.66%) tolerated post-operative pain on NSAID (injection diclofenac), while remaining28 patients (37.33%) required additional opiate (injection Nalbuphine). Mean post-operativehospital stay was 1.186 ±0.60 days. 1patient (1.33%) had port site infection. Conclusion:Midline three port laparoscopic cholecystectomy prevents one extra scar of traditional 4portlaparoscopic cholecystectomy. This technique is safe, efficient and feasible. This techniquecan be used as an alternative approach to traditional 4 port laparoscopic cholecystectomy inuncomplicated cases.</jats:p

Clinical Presentation of Patients of Carcinoma of Rectum and Different Modalites of Treatment

Objectives: To determine the clinical presentation of patients of Carcinoma of Rectum and Different modalities of treatment.&#x0D; Methodology: This was a Prospective observational study conducted in from May 2019 to April 2021 at Liaquat University of Medical and Health Sciences (LUMHS) Jamshoro, Sindh, Pakistan. The study comprises 50 patients. All were admitted from Outpatient Department (OPD).  All patients were evaluated fully after history &amp; Clinical examinations Digital Rectal Examination (DRE) with Proctoscope and specific investigations of, Stool DR, Fecal occult blood, ultra sound of abdomen and pelvis, Sigmoidoscopy, Colonoscopy with biopsy, Barium enema, C T Scan of Abdomen, chest &amp; pelvis, MRI Abdomen &amp;Pelvis, PECT Scan, Anorectal or Endoluminal Ultra sound, Tumor Marker CEA, Monoclonal Antibodies, LDH level, LFT for liver. and X-  Ray chest PA view. Complete blood picture (CBC) Blood urea, sugar, serum electrolyte, HBSAG, HCV, &amp; HIV, COVID -19, LFT, PT, APTT, INR and ECG for fitness purpose and general assessment.&#x0D; Results: In this study 50 patients of carcinoma of Rectum were reported. The maximum number of patients were in age group between 12 to 80 years. Out of 50 patient, 15  patients were presented with Altered Bowel habit (Constipation and Diarrhea)  &amp; Spurious Morning Diarrhea , 13  patients  were presented with Altered Bowel habit (Constipation &amp; Diarrhea)  Spurious Morning Diarrhea ,With Bleeding per rectum. Out of 50 patients   15 patients were diagnosed stage 1 ,13 patients were diagnosed stage 11, 9 patients were diagnosed stage 111, 13 patients were diagnosed stage 1V.  Out of 50 patients 28 patients were treated with anterior resection, 15 patients initially treated with New adjuvant therapy followed by patients were treated APR with TME, immunotherapy, gene therapy.  4 patients were treated initially diversion colostomy, then Neo adjuvant therapy, 3 patients were treated laparotomy, colostomy, hart men procedure, Chemo radio therapy, Immunotherapy, Gene therapy.&#x0D; Conclusion: Carcinoma of Rectum is a common problem all over the world. Patients of carcinoma rectum can present diarrhea, constipation, bleeding per rectum, spurious morning diarrhea if not diagnose, and treat the patient in early stage, patients live style will be complicated.</jats:p

To Evaluate the Outcome of Epididymal Cystectomy at Liaquat Medical College Hospital Jamshoro Pakistan

Introduction: Epididymal cystectomy is the procedure in which removal of cyst attached to epididymis is done. The cyst contains cleat/straw colored fluid. It is excised because of its increasing size causing discomfort or pain to patient.&#x0D; Methodology: A Cross sectional observational study was conducted at Surgical Unit 1, Department of of Surgery LMC Hospital Jamshoro from January 2020 to January 2021. All the patients were admitted through Surgical OPD (SOPD) with cystic swellings in scrotum. History and clinical examination of inguino-scrotal region was done. Transillimination test was also done. Ultrasound was obtained to confirm the diagnosis, number of cysts, sizes and site of cyst. Hydrocele, spermatocele and testicular malignancies were ruled out through investigations. Surgery was planned after getting cardiac and anesthesia fitness. The surgery was done. Patients were shifted to ward and assessed for 3 to 5 days. Patient was called for follow up for 6 months. Results were analyzed using statistical package for social sciences (SPSS) version 23.&#x0D; Results: Total patients included in our study are 49.32 (65%) patients had solitary cyst and 17 (35%) had multiple cysts. 30 (61.2%) patients had left sided epididymal cysts and 19 (38.7%) had right sided cysts. Hematoma was developed by 6.1%, chronic pain by 12.2%, infection by 8.1%, scrotal edema by 10.2% and recurrence by 6.1% patients.&#x0D; Conclusion: Epididymal cystectomy is the procedure with better outcome and least complications rate.</jats:p

Efficacy of Fine Needle Aspiration and Cytology in Solitary Thyroid Nodule

Objective: To determine the efficacy of fine needle aspiration and cytology (FNAC) in the solitary thyroid nodules at tertiary care Hospital.&#x0D; Materials and Methods: This study was conducted in department of general surgery at Liaquat University Hospital Jamshoro/ Hyderabad during one year from June 2015 May 2016. The study included all subjects of any gender and age who had a solitary nodule that was confirmed clinically or through thyroid scan. To achieve a tissue diagnosis before surgery, the study participants experienced fine needle aspiration cytology (FNAC). The resected specimens were submitted for histopathology investigation postoperatively. Diagnostic accuracy of FNAC was assessed by cross tabulation by taking histopathology as gold standard. The data was gathered by using a self-made proforma and analyzed with SPSS version 20.&#x0D; Results: Total fifty solitary thyroid nodules (STN) patients were studied. Mean age of the patients was 34.54+10.3 years. Of 50 patients, 46(92%) &amp; 4(8%) were females and males respectively with male &amp; female ratio of 1:11.5. 28(56%) STN were on right lobe, left side in 19(38%) cases; on isthmus in 3 (6%) cases. As per FNAC results, nodular colloid goiters were seen in 66% cases, follicular neoplasm in 10%, papillary carcinoma in 10%, Hurthle cell variation in 6%, benign cystic lesion in 4% of cases, neoplastic cystic lesion in only 1 case, and also only 1 study subject was suspected for malignancy. Thyroid function tests were normal in all patients. FNAC showed a significant efficacy with 83.3% sensitivity, 86.8% specificity, 86% diagnostic accuracy, 66.6% PPV and 94.28% NPV when histopathology was taken as a gold standard.&#x0D; Conclusion: In the conclusion of this study the FNAC observed to be a simple, safe and effective diagnostic tool in detecting the thyroid malignancies as solitary thyroid nodules with 83.3% and 86.8% sensitivity and specificity respectively.</jats:p

MALIGNANT THYROID DISEASE;

Objectives: To determine frequency of Transient &amp; permanent hypocalcemiaafter Thyroid Surgery for Malignant thyroid disease. Study Design: Observational study.Setting: Public &amp; Private Sector Hospitals of Hyderabad. Period: December 2008 to April 2016.Materials and Methods: All patients of Thyroid pathology who fulfilled the inclusion criteriawere admitted in the ward. They were evaluated preoperatively &amp; surgery was performed.Postoperatively patients were assessed clinically &amp; biochemically for Hypocalcaemia. Patient’sdata was recorded &amp; analyzed for variables like age, sex, diagnosis of thyroid disease on FNAC,Type of thyroid Malignancy, type of thyroid surgery, Transient &amp; permanent hypocalcemia inrelation to type of type of thyroid surgery performed &amp; the hospital stay. Results: Total 254patients were operated for different thyroid pathologies. It includes 91(35.82%) male &amp; and163 (64.17%) female patients making ratio of 1: 1.79. Mean age was 37.29 ±7.4 years.Amongst them 33 patients were diagnosed as Malignant Thyroid diseases. Most commontype of thyroid malignancy detected was papillary carcinoma in 48.48% patients followed byfollicular carcinoma in 42.42% patients. Most common surgical procedures performed includescompletion thyroidectomy in 57.57% patients with 01(3.03%) of them underwent cervicalneck dissection followed by total thyroidectomy in 36.36% patients with 02(6.06%) of themunderwent cervical neck dissection. Postoperative hypocalcemia was noted in 45.45% patientswith 36.36% patients developed hypocalcemia within 24 hours of operation, 6.06% within 24to 48 hours &amp; 3.03% patients after 48 hours of surgery. Transient hypocalcemia was noticed in13/33 (39.39%) cases &amp; permanent hypocalcemia in 02/33(6.06%) patients. Mean hospital staywas 4.13± 0.32 days. Conclusion: Hypocalcaemia was noted in 15(45.45%) patients operatedfor thyroid Malignancy. Revision surgery &amp; cervical lymph node dissection were noted as riskfactors.</jats:p

Emergency Treatment of Patients of Thoraco Abdominal Trauma in Surgical Ward According to Advanced Trauma and Life Support (ATLS)

Objective: To determine the emergency treatment of Patients of Thoraco abdominal trauma in surgical ward according to Advance trauma and life support (ATLS).&#x0D; Methodology: Prospective observational study was conducted for two years from April 2018 to March 2020 at Liaquat university of Medical and Health Sciences Jamshoro/Hyderabad Hospital. The study comprises 50 patients. All were admitted from Emergency department. The patients were evaluated fully after history &amp; clinical examinations. Results were analyzed by using statistical package for social sciences (SPSS) version 23.&#x0D; Results: In this study of 50 patients of Thoraco abdominal trauma, the maximum numbers of patients were in age group 15-70 years. Out of 50 patients 25 patients were presented with Trauma in Thorax, in which 5 patients were presented with penetrating injury &amp; 20 patients were presented with Blunt trauma, 10 patients were presented with combine Thoraco abdominal trauma in which 2 patient were presented with penetrating injury &amp; 8 patients were presented with Blunt trauma. Related to chest trauma 10 patients were treated needle thoracotomy with chest intubation, 5 patients were treated endotracheal intubation, 3 patients were treated thoracotomy and 2 patients were treated cardiosentesis, 5 patients were treated cricothyroidotomy. Better out were seen in 45 patients and mortality were seen in 5 patients.&#x0D; Conclusion: Advance trauma and life support (ATLS) has a vital role in thoraco abdominal trauma intervention. 90% of successful interventions were obtained using advance trauma and life support.</jats:p

Complications of Advanced Stage of Various Types of Thyroid Tumors at Tertiary Care Hospital

Objective: To determine the complications associated various types of tumors of advanced stage of thyroid disease at tertiary care hospital.&#x0D; Study Design: Descriptive study.&#x0D; Place and Duration: Two years study from April 2018 to March 2020 was conducted in Liaquat University of Medical and health sciences Jamshoro.&#x0D; Patients and Methods: All patients were admitted from Outpatient department (OPD) with advance stage of tumor of thyroid and either of gender were included. The patients were evaluated fully after history and clinical examinations berries sign and specific investigations of thyroid profile (T3,T4,TSH), ultrasound of thyroid,  fine-needle aspiration cytology FNAC, image guided biopsy,  frozen section biopsy  for confirmation  of diagnosis, indirect laryngoscopy,  x - Ray neck  and MRI. All the patients were assessed for pre-operative evaluation (complications) with advanced stage of thyroid tumors. All the data regarding developed complications was recorded via study proforma. Data was analyzed by using the SPSS version 20.  &#x0D; Results: Most of the patients were found with age groups of 20 to 34 years and 35 to 55 years. Out of all, 25 patients were diagnosed papillary carcinoma, 12 patients were diagnosed as follicular carcinoma, 7 patients had Anaplastic carcinoma, 4 patients were diagnosed lymphoma and 2 patients were diagnosed as medullary carcinoma. As per complications of advanced disease 23 patients had thyroid swelling with cervical lymphadenopathy and pain, 13 patients had thyroid swelling with change of voice, 7 patients had thyroid swelling with dyspnea and dysphagia, 5 patients were  presented with thyroid swelling with bony pain, weight loss and pathological fractures, 2 patients were presented with thyroid swelling with diarrhea.&#x0D; Conclusion: Various complications such as swelling, pain, hemorrhage, cervical lymphadenopathy, change in voice, weight loos, pathological fracture, dyspnea and dysphagia were frequently seen in patients presented with advanced stage of thyroid disease.</jats:p