Surgical palliation for unresectable pancreatic carcinoma

Objectives: To review the results of surgical palliation for unresectable pancreatic carcinoma, and to analyze the morbidity and mortality associated with the surgical procedure. The reasons for readmission after discharge from the hospital were also analyzed.Methods: A retrospective study from 1995 to 2001 was done on 30 patients with pancreatic cancer operated with palliative intent, or those explored with curative intent but histopathology revealed positive resection margins or lymph node metastasis.Results: Twenty-five (83.25%) patients were above 50 years of age. There were 16 (53.28%) male, and 14 (46.62%) females, 8 (26.64%) had diabetes mellitus, 2 (6.66%) chronic pancreatitis and 4 (13.32%) had smoking as risk factors. Twenty-three (76.59%) patients presented with jaundice, 18 (59.94%) with weight loss, 17 (56.61%) with epigastric pain, 15 (49.95%) with anorexia and 14 (46.62%) with vomiting. Whipple\u27s procedure was performed in 9 (29.97%) patients, triple bypass in 13 (43.29%), choledochojejunostomy and gastrojejunostomy in 3 (9.99%) and gastrojejunostomy alone in 5 (16.65%) patients. Seven (23.31%) patients had preoperative ultrasonography, while CT Scan was done in 24 (79.92%) and ERCP in 8 (26.64%) patients. Histopathology showed positive resection margins in 9 (29.97%) patients and lymph node metastasis in 5 (16.65%) patients. Seventeen (56.61%) patients received less than 2 units of pack cells transfusion. Most of the patients remained admitted in the hospital between 20 to 30 days. Post-operatively, delayed gastric emptying was detected in 6 (19.98%) patients, cholangitis in 2 (6.66%), wound infection in 3 (9.99%), anastomotic leak in 2 (6.66%) and line sepsis in 2 (6.66%) patients. Three (9.99%) patients expired in hospital post operatively. The reasons for re-admission after discharge included abdominal pain in 9 (29.97%) patients, anemia in 3 (9.99%), intestinal obstruction in 3 (9.99%) and urinary tract infection in 2 (6.66%) patients. Follow up record was available for 22 (73.26%) patients. Six (19.98%) patients survived for 5 to 6 months and 9 (29.97%) had a survival between 7 to 10 months.CONCLUSION: A single surgical procedure can palliate all three symptoms associated with unresectable pancreatic carcinoma, and can be carried out with reasonable safety in selected patients. The commonest indication for re-admission is severe abdominal pain associated with advanced malignancy, hence chemical splanchiectomy may also be considered at the time of surgical exploration

Surgical management of blunt pancreatic trauma: A modus operandi or individualized therapy?

The overall rate of blunt pancreatic trauma observed in level one trauma centers is rather low compared to other injuries, with a reported prevalence of 0.4 per 100,000 hospital admissions. The situation may be further complicated by the presence of associated major visceral injuries in these patients. A number of previous reports indicate that blunt pancreatic trauma carries high morbidity and mortality rates, especially when diagnosis is delayed or inappropriate surgery is attempted. Many mandate prompt surgical explorations for organ-specific diagnosis on CT; however other literature and upcoming studies prove otherwise. Over the years, several technologic advances have increased the sophistication of non-operative management. In our case, a period of careful observation followed by surgical intervention did not adversely effect the outcome. The period of observation resulted in stabilization of other solid organ injuries with focus on pancreas during surgical exploration

A Comparative Study of Consumer Perception of Product Quality: Chinese versus Non-Chinese Products

Product quality is a critical determinant of consumer satisfaction. The demand for a product depends upon the quality that a manufacturer is providing to their consumers. China, which is a growing economic power, exports its manufactured goods to the entire global markets. Chinese goods have been successful to capture market because of its competitive price strategy as compared to the products of other countries. The major problem with the Chinese products is that these are perceived as of relatively inferior quality in comparison to the products of other countries. This study is an attempt to assess the perceptions of customers regarding price and quality aspects of Chinese and non Chinese products. To compare the relative effectiveness of price and quality, the concepts of perceived life and perceived value are used. It is found that the Chinese products are perceived as price effective but the area of product quality requires immediate attention because Chinese products are perceived as of low qualit

Apprenticeship to simulation - The metamorphosis of surgical training

Surgery is a dynamic specialty and surgical competencies are a combination of both technical and non-technical skills. After the inception of the art of surgery, surgical education and training has undergone incredible evolution. The first model of surgical training was introduced in the 19th century and is known as the \u27apprenticeship model\u27, followed by the famous \u27Halstedian\u27 model. However, a report by the Institute of Medicine challenged the teaching institutions to formulate alternative methods of surgical education to ensure patients\u27 safety and to reduce the fear among patients of them being practised on. Teaching surgical skills outside the operating room to ensure patient safety has laid the foundation of simulation-based training in surgical education. More recently, the focus of surgical training and residency has shifted to competency and outcome-based models. The current review article was planned to describe the evolution and transformation of surgical training over time

Short-term outcomes after hepatic resection : perspective from a developing country

Abstract Objective: To review the early outcomes of hepatic resection at our hospital. Methods: This study was conducted at the Aga Khan University Hospital, Karachi, from January 2008 to December 2015, and comprised patients who underwent hepatic resection. We analysed the pathology, magnitude of hepatic resection and short-term outcomes in the patients. Mean and standard deviations were used to describe categorical data whereas frequencies and proportions to describe quantitative data. Univariate analysis was done to look at the factors associated with morbidity, mortality and blood loss during surgery. SPSS 19 was used for data analysis. Results: Of the 75 participants, 43(57.3%) were males and 32(42.7%) were females. The overall mean age was 52±14 years. Besides, 37(49.3%) patients underwent hepatic resection for underlying hepatocellular carcinoma, with 30(81%) of them being cirrhotic. Major hepatectomy (\u3e3 segments) was performed in 30(40%) patients. Postoperative complications were observed in 30(40%) patients including postoperative liver failure in 3(4%) patients. The presence of one or more co-morbid conditions had a statistically significant association with postoperative morbidity (p=0.018). Mortality rate at 30days and 90days were 3(4%) and 5(6.7%), respectively. Discussion: Morbidity, mortality and blood loss were comparatively higher in cirrhotic patient

Management outcome of residual common bile duct stones at Aga Khan University Hospital

Background: The frequency of residual common bile duct (CBD) stones in patients with previous cholecystectomy ranges from 2-10%, and a minimally invasive approach is generally recommended for these patients. This study reviews the experience in the management of residual CBD stones at the Aga Khan University Hospital.Methods: All adult patients diagnosed to have residual CBD stones, from 1993 to 2001, were identified and analyzed in terms of the treatment modality utilized and its associated complications. The role of endoscopic sphincterotomy was particularly analyzed in our set-up.Results: The study population consisted of 66 patients. The mean age was 52 (range:18-84 years) years with a female to male ratio of 51:15. The primary mode of management consisted of endoscopic sphincterotomy in 61 patients (92.5%). The initial clearance rate for these patients was 75%, while the remaining 25% required ancillary procedures to achieve a complete clearance. Procedure related complications were observed in 17 (28%) patients, with zero mortality. The other 5 patients (7.5%) underwent an open choledochotomy as a primary procedure with no further complications.CONCLUSIONS: Endoscopic sphincterotomy is the most frequent treatment modality used for the management of residual CBD stones at our hospital. Although initial success rate seems low, the fact that endoscopic sphincterotomy is a less invasive procedure justifies its preferential utilization. The study does not compare the results of endoscopic management with open surgery, as the number of patients managed by open choledochotomy is very small

Long-run Performance of Public vs. Private Sector Initial Public Offerings in Pakistan

The private sector had its major share in the economic development of the country in the early years of its independence in the 1950s. However, the private sector suffered a set back in the early 1970s, when a huge process of nationalisation of a large number of private industrial units was undertaken by the then government. Over the decades these enterprises were not professionally managed and the political influences in the management and running of these enterprises played havoc with them and consequently the experiment proved to be a failure. Attending to the weaknesses and inefficiencies inherent in the public sector enterprises, privatisation was systematically initiated by the then government in the early 1990s. Various privatisation commissions were set up in subsequent years and the privatisation process got some momentum during the present government and many large and profitable firms were privatised in the last few years, particularly at a time when the overall climate in the country was responsive and conducive for investment. The government, however, privatised many enterprises through public offerings on individual-case basis