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Javaid R.H.,Combined Military Hospital Rawalpindi
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2011

To assess the long term complications of level II Axillary Lymph Node Dissection (AXLND) in patients with breast cancer and to see if they are high enough to warrant a Sentinel Lymph Node (SLN) biopsy in all patients presenting with carcinoma breast in our setup in Pakistan. This study was conducted at Surgical Unit IV, Department of Surgery, Combined Military Hospital, Rawalpindi. Upper, lower arm circumferences and body mass index were ascertained in post Modified Radical Mastectomy (MRM) with level II AXLND, in female patients who had undergone surgeries from 1992 to 2008. Patient's perception of degree of lymph oedema, arm function and other symptoms like pain, tingling and numbness was noted. The number of lymph nodes removed, number of positive nodes and post operative radiotherapy were also recorded from the hospital records. Thus upper arm circumference in 85.7% patients and lower arm circumference in 89.2% patients was within 2 Cm of the unaffected side. No, moderate and severe arm swelling was described by 83.35% of patients, 11.6% of patients and one patient respectively and 41.5% of patients describing some arm swelling had positive lymph nodes. Thus even if they had gone (SLN) biopsy, these patients would have had a subsequent AXLND. Over 94% of patients had either good or excellent arm function with most in the excellent range. The patients at significant risk for positive nodal may be better served with an AXLND rather than the SLN technique.


Asghar A.,Combined Military Hospital Rawalpindi | Rashid M.,Combined Military Hospital Rawalpindi | Saeed I.,Combined Military Hospital Rawalpindi | Umair B.,Combined Military Hospital Rawalpindi | And 3 more authors.
Pakistan Journal of Medical and Health Sciences | Year: 2011

Objective: To compare the efficacy of Video-assisted Thoracoscopic Talc Pleurodesis (VATP) to pleurodesis through chest tube for cases having Malignant Pleural effusion Design : Controlled clinical Trial Setting: Combined Military Hospital Rawalpindi , 1200 bedded, tertiary care hospital. Duration: The study was conducted from Jun 2006 to Jun 2007. Sampling technique: Purposive non-probability Patients and Methods: The study was conducted at Combined Military Hospital Rawalpindi from Jun 2006 to Jun 2007. After informed consent and approval from hospital ethical committee, 60 patients with proven diagnosis of malignant pleural effusion were included in the study. Minimum criteria for diagnosis of malignant pleural effusion were radiological evidence of pleural effusion on Plain X-Ray and CT-scan and presence of malignant cells in the pleural fluid. Patients with secondarily infected effusions, trapped lungs, and those with renal, hepatic, cardiac causes of effusions were excluded from the study. Patients who were fit for GA [ ASA-grade III ] were subjected to video-assisted thoracoscopic insufflations of talc ( labeled as VATS Pleurodesis-Group A) while other had conventional pleurodesis through chest tube using talc solution (Slurry Pleurodesis-Group B). Outcome was measured along three parameters: improvement in chest pain and dyspnoea, and duration of chest tube placement. Data was entered on SPSS-10; Chi-square test and paired-sample t-test were applied to compare extubation time and level of dyspnoea and pre and post-operative pain respectively. Values, less than 0.05 were considered statistically significant [P< 0.05]. Results: Group A (VATS) had 87.5 % (14/16) (n = 16) successful pleurodesis as far as duration of chest tube drainage was concerned whereas Group B had only 54 % (13/24) (n = 24) successful pleurodesis indicating significant difference (P value < 0.05 for extubation timing). However there was no significant difference in reduction of post procedural chest pain and dyspnoea in two groups (P value > 0.05). Conclusion: Video-assisted thoracoscopic Talc pleurodesis is a better therapeutic procedure than tube thoracostomy pleurodesis for cases of malignant pleural effusion.


Sajid M.T.,Combined Military Hospital Rawalpindi | Hussain S.M.,Combined Military Hospital Rawalpindi | Bashir R.A.,Combined Military Hospital Rawalpindi | Mustafa Q.A.,Combined Military Hospital Rawalpindi | And 3 more authors.
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2014

BACKGROUND: Cholecystectomy is the most frequently performed abdominal operation and currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in 90% cases of symptomatic gallstones in USA since 1992. The aim of the study was to determine results obtained with LC at our setup.METHODS: This observational case series study was conducted in department of General Surgery, Combined Military Hospital, Rawalpindi, from August 2009 to August 2011. The study participants were patients of both gender aged 14-75 years undergoing LC. Surgery was performed by consultant as well as resident surgeon. Demographic variables, intraoperative findings, mean operation time, hospital stay, conversion rate, morbidity and mortality were evaluated. Factors influencing rate of conversion were also studied.RESULTS: A total of 504 patients were included. Mean age was 42.64 years (range 14-75 years) with a female: male ratio of 3.9:1.2. Comorbidities were found in 36.7% patients. Main indication of surgery was symptomatic cholelithiasis (78.57%). Mean operative time was 40.1 ± 6.9 minutes which increased to 75.12 ± 8.9 minutes in converted cases (p-value .000). Mean hospital stay was 1.89 ± 1.1 days that significantly increased in converted cases (5.7 ± 1.6 days) (p-value .000). Major surgical complications occurred in 3.17% patients. Common bile duct injury (CBDI) was found in 04 cases (0.79%). Conversion to laparotomy was required in 3.97% cases. Factors that influenced the rate of conversion included: age > 60 years, acute cholecystitis, coexisting diseases, ASA grade III/IV and inexperienced surgeon (p-value .000). Total complication rate was 3.56%, morbidity being 3.17% and mortality 0.39%.CONCLUSION: Laparoscopic cholecystectomy offers shorter hospital stay and low morbidity/mortality. The operative time is short and procedure is standard, safe and effective method both for uncomplicated and complicated cholelithiasis.

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