Summary Background Elective splenectomy has various indications and can be performed open or mini... more Summary Background Elective splenectomy has various indications and can be performed open or minimally invasively. Laparoscopic splenectomy (LS) is popular but has limitations. Some studies suggest potential superiority of robotic splenectomy (RS) over LS. As such, we conducted a systematic review to determine whether RS has greater positive perioperative outcomes in comparison to LS in the adult population. Methods We searched for studies that reported perioperative outcomes and compared RS to LS in the adult population. Outcome measures were operative time, conversion to open surgery, postoperative complications, mortality, length of stay, blood loss and cost analysis. A simple, unpaired two-tailed student’s t‑test was used to compare outcomes between the RS and LS patient groups. Results After full-text analysis of 47 papers, three studies met the inclusion criteria. The studies involved 72 patients (28 in the RS group, 44 in the LS group). RS demonstrated no significantly reduce...
HPB : the official journal of the International Hepato Pancreato Biliary Association, Jan 25, 2018
Blood group is reported to have an effect upon survival following pancreatoduodenectomy for pancr... more Blood group is reported to have an effect upon survival following pancreatoduodenectomy for pancreatic ductal adenocarcinoma. The effect of blood group is not known, however, among patients with other periampullary cancers. This study sought to review this. Data were collected for a range of factors and survival outcomes from patients treated at two centres. Those with blood groups B and AB were excluded, due to small numbers. Patient survival was compared between patients with blood groups O and A using multivariable analysis which accounted for confounding factors. Among 431 patients, 235 (54.5%) and 196 (45.5%) were of blood groups A and O respectively. Baseline comparisons found a significant difference in the distribution of tumour types (p = 0.011), with blood group O patients having more ampullary carcinomas (33.2% vs 23.4%) and less pancreatic ductal adenocarcinomas (45.4 vs 61.3%) than group A. On multivariable analysis, after accounting for confounding factors including pa...
Herbal and dietary supplement (HDS) hepatotoxicity is increasingly being reported in the USA. Thi... more Herbal and dietary supplement (HDS) hepatotoxicity is increasingly being reported in the USA. This case series describes the presenting clinical features and outcomes of seven patients with liver injury attributed to OxyELITE Pro enrolled in the Drug-Induced Liver Injury Network (DILIN) study. The 6-month outcomes of patients with hepatotoxicity attributed to OxyELITE Pro enrolled in the DILIN prospective registry between 2004 and 2015 are presented. Six of the seven patients (86 %) presented in 2013 with symptoms of hepatitis and acute hepatocellular injury. The median duration of OxyELITE Pro use was 18 weeks (range 5-102 weeks). Median age was 36 years (range 28-62), 86 % were female, and 43 % were Asian. One patient had rash, none had eosinophilia, and three had antinuclear antibody reactivity. The median peak ALT was 2242 U/L, alkaline phosphatase 284 U/L and bilirubin 15.0 mg/dL. Six patients (86 %) were hospitalized, three developed acute liver failure and two underwent liver...
Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology
Mycophenolate mofetil (MMF) is an immunosuppressive agent commonly used after organ transplantati... more Mycophenolate mofetil (MMF) is an immunosuppressive agent commonly used after organ transplantation. Gastrointestinal side effects occur in approximately 45% of patients. The spectrum of histologic features associated with MMF colitis has been well described, but data on the endoscopic features is lacking. The aim of the study was to describe the endoscopic features of MMF colitis in solid organ transplant recipients (SOTRs) as well as the frequency of histologic features and identify associated risk factors. A retrospective review of all SOTRs taking MMF and who underwent colonoscopy between 2000 and 2010 was performed. 36 cases of MMF colitis were identified and 361 patients served as controls. Descriptive statistics and data analysis looking for associated risk factors were performed. Among SOTRs taking MMF who underwent colonoscopy, MMF colitis was diagnosed in 9%. Endoscopic findings ranged from erythema (33%) to erosions/ulcers (19%). 47% of patients had a normal colonoscopy a...
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2008
Adenocarcinoids are rare and aggressive tumors with histological features of both carcinoid tumor... more Adenocarcinoids are rare and aggressive tumors with histological features of both carcinoid tumor and adenocarcinoma. We report a case of a 32-year-old man with diffuse infiltration of the appendix wall and mesoappendix by an adenocarcinoid. Due to the involvement, a hemicolectomy was performed at a later date. We suggest that patients with diffuse appendiceal involvement require an aggressive surgical therapy and follow-up.
Bile duct injury is a rare complication of cholecystectomy. The aims of this study were to analys... more Bile duct injury is a rare complication of cholecystectomy. The aims of this study were to analyse the mechanism and outcome of biliary complications and determine the Northern Ireland incidence of bile duct injury over the last decade. Annual numbers of cholecystectomies were obtained from the Northern Ireland Hospital Inpatient System database. Bile duct injury referrals to a hepatobililary unit over an 11-year period from 2000 were reviewed. Mechanism and recognition of injury, referral interval, management and outcome were analysed. The annual incidence of laparoscopic cholecystectomy in Northern Ireland increased from 0.038% in 1995 to 0.101% in 2009. Thirty-five patients with biliary complications from cholecystectomy were referred from 2000. The incidence of bile duct injury associated with laparoscopic cholecystectomy during this period was 0.2%. Only 26% of injuries were recognised intra-operatively, only 40% were referred immediately and 91% required operative intervention...
JPMA. The Journal of the Pakistan Medical Association, 2007
Gallstone ileus is rare following an Endoscopic Retrograde Cholangio-Pancreaticography (ERCP). We... more Gallstone ileus is rare following an Endoscopic Retrograde Cholangio-Pancreaticography (ERCP). We present a case where gallstones caused ileus and perforation of small bowel after a therapeutic ERCP. There was no previous history of instrumentation of the papilla or a cholecystoenteric fistula. This case points out a serious morbidity of therapeutic ERCP for large common bile duct stones.
The commonest cause of gastric outlet obstruction (GOO) is pyloric stenosis secondary to peptic u... more The commonest cause of gastric outlet obstruction (GOO) is pyloric stenosis secondary to peptic ulcer disease or gastric carcinoma. Patients with GOO have unique metabolic sequelae, namely hypochloraemic, hypokalaemic metabolic alkalosis with paradoxical aciduria and hypocalcaemia. A case of a patient presenting as GOO is discussed. The aim of this report is to highlight the metabolic abnormalities and management in patients with GOO.
Journal of Ayub Medical College, Abbottabad : JAMC
The specialty of thoracic anaesthesia has emerged as a scientifically based discipline just 30 ye... more The specialty of thoracic anaesthesia has emerged as a scientifically based discipline just 30 years back. At the start of the 20th century empyema and tuberculosis were the main indications for the thoracic surgery. Later on with the introduction of antibiotics lung malignancies were more commonly operated. Recent resurgence of tuberculosis and associated medical illnesses put these patients in high risk for surgery and anaesthesia, necessitating introduction of more skillful approach. The objective of this study was to evaluate the effectiveness of combined thoracic epidural anaesthesia and light general anaesthesia in patients undergoing non-cardiac thoracic surgery. This study was conducted at the department of Anesthesia and Intensive care, Pakistan Institute of Medical Sciences, Islamabad from 1st Jan 2001 to 31st August 2002. Ten adult patients of both sexes of ASA grade I-III, < 68 years of age, who were undergoing non-cardiac thoracic surgery were included. Thoracic epid...
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2009
Diverticular disease affects more than 50% of the population over the age of 60 years in the west... more Diverticular disease affects more than 50% of the population over the age of 60 years in the west and becomes even more common as the population ages. Diverticulitis is one of the complications of diverticular disease and can culminate into colonic perforation. Though perforated diverticular disease is not uncommon, synchronous colonic perforations in diverticulitis is rare. Our patient was admitted with acute abdomen and exploratory laparotomy revealed two side-by-side perforations of the sigmoid colon. A Hartmann's procedure was performed. Macro- and microscopic evaluation confirmed the presence of two perforated sigmoid diverticula due to diverticulitis. Simultaneous perforation of two abreast sigmoid diverticula is uncommon; thus, a cautious surgeon should always take into account such a probable diagnosis.
The Journal of Infection in Developing Countries, 2014
Introduction: Knowledge of the etiology and antimicrobial susceptibility patterns of uropathogens... more Introduction: Knowledge of the etiology and antimicrobial susceptibility patterns of uropathogens is important for determining the best treatment option. This study aimed to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from adult male outpatients. Methodology: Between November 2012 and April 2013, 3,105 community urine samples were analyzed from adult male patients who attended the Laboratorio Hidalgo, Buenos Aires, Argentina. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method. Isolates resistant to third generation cephalosporin were tested for extended-spectrum beta-lactamase (ESBL) production using the double-disk synergy test. Results: Of the 3,105 urine samples analyzed, 791 (25.5%) had significant bacteriuria. The frequency of positive urine cultures increased significantly with patient age. Escherichia coli was isolated most frequently (47.3%), followed by Enterococcus faecalis (13.6%)...
Summary Background Elective splenectomy has various indications and can be performed open or mini... more Summary Background Elective splenectomy has various indications and can be performed open or minimally invasively. Laparoscopic splenectomy (LS) is popular but has limitations. Some studies suggest potential superiority of robotic splenectomy (RS) over LS. As such, we conducted a systematic review to determine whether RS has greater positive perioperative outcomes in comparison to LS in the adult population. Methods We searched for studies that reported perioperative outcomes and compared RS to LS in the adult population. Outcome measures were operative time, conversion to open surgery, postoperative complications, mortality, length of stay, blood loss and cost analysis. A simple, unpaired two-tailed student’s t‑test was used to compare outcomes between the RS and LS patient groups. Results After full-text analysis of 47 papers, three studies met the inclusion criteria. The studies involved 72 patients (28 in the RS group, 44 in the LS group). RS demonstrated no significantly reduce...
HPB : the official journal of the International Hepato Pancreato Biliary Association, Jan 25, 2018
Blood group is reported to have an effect upon survival following pancreatoduodenectomy for pancr... more Blood group is reported to have an effect upon survival following pancreatoduodenectomy for pancreatic ductal adenocarcinoma. The effect of blood group is not known, however, among patients with other periampullary cancers. This study sought to review this. Data were collected for a range of factors and survival outcomes from patients treated at two centres. Those with blood groups B and AB were excluded, due to small numbers. Patient survival was compared between patients with blood groups O and A using multivariable analysis which accounted for confounding factors. Among 431 patients, 235 (54.5%) and 196 (45.5%) were of blood groups A and O respectively. Baseline comparisons found a significant difference in the distribution of tumour types (p = 0.011), with blood group O patients having more ampullary carcinomas (33.2% vs 23.4%) and less pancreatic ductal adenocarcinomas (45.4 vs 61.3%) than group A. On multivariable analysis, after accounting for confounding factors including pa...
Herbal and dietary supplement (HDS) hepatotoxicity is increasingly being reported in the USA. Thi... more Herbal and dietary supplement (HDS) hepatotoxicity is increasingly being reported in the USA. This case series describes the presenting clinical features and outcomes of seven patients with liver injury attributed to OxyELITE Pro enrolled in the Drug-Induced Liver Injury Network (DILIN) study. The 6-month outcomes of patients with hepatotoxicity attributed to OxyELITE Pro enrolled in the DILIN prospective registry between 2004 and 2015 are presented. Six of the seven patients (86 %) presented in 2013 with symptoms of hepatitis and acute hepatocellular injury. The median duration of OxyELITE Pro use was 18 weeks (range 5-102 weeks). Median age was 36 years (range 28-62), 86 % were female, and 43 % were Asian. One patient had rash, none had eosinophilia, and three had antinuclear antibody reactivity. The median peak ALT was 2242 U/L, alkaline phosphatase 284 U/L and bilirubin 15.0 mg/dL. Six patients (86 %) were hospitalized, three developed acute liver failure and two underwent liver...
Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology
Mycophenolate mofetil (MMF) is an immunosuppressive agent commonly used after organ transplantati... more Mycophenolate mofetil (MMF) is an immunosuppressive agent commonly used after organ transplantation. Gastrointestinal side effects occur in approximately 45% of patients. The spectrum of histologic features associated with MMF colitis has been well described, but data on the endoscopic features is lacking. The aim of the study was to describe the endoscopic features of MMF colitis in solid organ transplant recipients (SOTRs) as well as the frequency of histologic features and identify associated risk factors. A retrospective review of all SOTRs taking MMF and who underwent colonoscopy between 2000 and 2010 was performed. 36 cases of MMF colitis were identified and 361 patients served as controls. Descriptive statistics and data analysis looking for associated risk factors were performed. Among SOTRs taking MMF who underwent colonoscopy, MMF colitis was diagnosed in 9%. Endoscopic findings ranged from erythema (33%) to erosions/ulcers (19%). 47% of patients had a normal colonoscopy a...
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2008
Adenocarcinoids are rare and aggressive tumors with histological features of both carcinoid tumor... more Adenocarcinoids are rare and aggressive tumors with histological features of both carcinoid tumor and adenocarcinoma. We report a case of a 32-year-old man with diffuse infiltration of the appendix wall and mesoappendix by an adenocarcinoid. Due to the involvement, a hemicolectomy was performed at a later date. We suggest that patients with diffuse appendiceal involvement require an aggressive surgical therapy and follow-up.
Bile duct injury is a rare complication of cholecystectomy. The aims of this study were to analys... more Bile duct injury is a rare complication of cholecystectomy. The aims of this study were to analyse the mechanism and outcome of biliary complications and determine the Northern Ireland incidence of bile duct injury over the last decade. Annual numbers of cholecystectomies were obtained from the Northern Ireland Hospital Inpatient System database. Bile duct injury referrals to a hepatobililary unit over an 11-year period from 2000 were reviewed. Mechanism and recognition of injury, referral interval, management and outcome were analysed. The annual incidence of laparoscopic cholecystectomy in Northern Ireland increased from 0.038% in 1995 to 0.101% in 2009. Thirty-five patients with biliary complications from cholecystectomy were referred from 2000. The incidence of bile duct injury associated with laparoscopic cholecystectomy during this period was 0.2%. Only 26% of injuries were recognised intra-operatively, only 40% were referred immediately and 91% required operative intervention...
JPMA. The Journal of the Pakistan Medical Association, 2007
Gallstone ileus is rare following an Endoscopic Retrograde Cholangio-Pancreaticography (ERCP). We... more Gallstone ileus is rare following an Endoscopic Retrograde Cholangio-Pancreaticography (ERCP). We present a case where gallstones caused ileus and perforation of small bowel after a therapeutic ERCP. There was no previous history of instrumentation of the papilla or a cholecystoenteric fistula. This case points out a serious morbidity of therapeutic ERCP for large common bile duct stones.
The commonest cause of gastric outlet obstruction (GOO) is pyloric stenosis secondary to peptic u... more The commonest cause of gastric outlet obstruction (GOO) is pyloric stenosis secondary to peptic ulcer disease or gastric carcinoma. Patients with GOO have unique metabolic sequelae, namely hypochloraemic, hypokalaemic metabolic alkalosis with paradoxical aciduria and hypocalcaemia. A case of a patient presenting as GOO is discussed. The aim of this report is to highlight the metabolic abnormalities and management in patients with GOO.
Journal of Ayub Medical College, Abbottabad : JAMC
The specialty of thoracic anaesthesia has emerged as a scientifically based discipline just 30 ye... more The specialty of thoracic anaesthesia has emerged as a scientifically based discipline just 30 years back. At the start of the 20th century empyema and tuberculosis were the main indications for the thoracic surgery. Later on with the introduction of antibiotics lung malignancies were more commonly operated. Recent resurgence of tuberculosis and associated medical illnesses put these patients in high risk for surgery and anaesthesia, necessitating introduction of more skillful approach. The objective of this study was to evaluate the effectiveness of combined thoracic epidural anaesthesia and light general anaesthesia in patients undergoing non-cardiac thoracic surgery. This study was conducted at the department of Anesthesia and Intensive care, Pakistan Institute of Medical Sciences, Islamabad from 1st Jan 2001 to 31st August 2002. Ten adult patients of both sexes of ASA grade I-III, < 68 years of age, who were undergoing non-cardiac thoracic surgery were included. Thoracic epid...
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2009
Diverticular disease affects more than 50% of the population over the age of 60 years in the west... more Diverticular disease affects more than 50% of the population over the age of 60 years in the west and becomes even more common as the population ages. Diverticulitis is one of the complications of diverticular disease and can culminate into colonic perforation. Though perforated diverticular disease is not uncommon, synchronous colonic perforations in diverticulitis is rare. Our patient was admitted with acute abdomen and exploratory laparotomy revealed two side-by-side perforations of the sigmoid colon. A Hartmann's procedure was performed. Macro- and microscopic evaluation confirmed the presence of two perforated sigmoid diverticula due to diverticulitis. Simultaneous perforation of two abreast sigmoid diverticula is uncommon; thus, a cautious surgeon should always take into account such a probable diagnosis.
The Journal of Infection in Developing Countries, 2014
Introduction: Knowledge of the etiology and antimicrobial susceptibility patterns of uropathogens... more Introduction: Knowledge of the etiology and antimicrobial susceptibility patterns of uropathogens is important for determining the best treatment option. This study aimed to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from adult male outpatients. Methodology: Between November 2012 and April 2013, 3,105 community urine samples were analyzed from adult male patients who attended the Laboratorio Hidalgo, Buenos Aires, Argentina. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method. Isolates resistant to third generation cephalosporin were tested for extended-spectrum beta-lactamase (ESBL) production using the double-disk synergy test. Results: Of the 3,105 urine samples analyzed, 791 (25.5%) had significant bacteriuria. The frequency of positive urine cultures increased significantly with patient age. Escherichia coli was isolated most frequently (47.3%), followed by Enterococcus faecalis (13.6%)...
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