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Objective: The objective of this study was to determine the prevalence of presumed ocular tuberculosis among diagnosed pulmonary tuberculosis patients. Method: It was a cross-sectional study in which 150 patients who were labeled to have active pulmonary tuberculosis underwent history and ocular examination prior to anti-tubercular therapy. The diagnosis of presumed ocular tuberculosis was made when clinical signs of tuberculosis (TB) uveitis were found in the participants. Lesions were documented and tallied, after which statistical analysis was performed. Results: 10 of the 150 pulmonary TB patients (6.8% prevalence: 95% CI 2.78% to 13.5%) included in the study showed signs of ocular inflammation. There was no sex and age predilection between those with presumed ocular TB and those without. Posterior uveitis alone was observed in three of the patients (two cases of retinal vasculitis and one case of choroidal tubercle). Non-granulomatous anterior uveitis with posterior synechiae alone was observed in two patients. One patient had combined non-granulomatous anterior uveitis with posterior synechiae and choroidal tubercle. One had combined granulomatous anterior uveitis with posterior synechiae and choroidal tubercle. Intermediate uveitis was not noted among the patients. Conclusion: Presumed ocular tuberculosis should be considered among patients with diagnosed pulmonary tuberculosis. Common ocular lesions found in the study include choroidal tubercle and non-granulomatous anterior uveitis with posterior synechiae. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy is the par excellence surgical treatment for gallstone disease. In spite of numerous benefi ts on top of open cholecystectmy, some patients had pain around the shoulder tip aft er laparoscopic cholecystectmy. Th e goal of our study was to assess frequency, signifi cant or non-signifi cant factors may aff ect on incidence or severity and distinct surgical techniques to keep down shoulder tip pain. Material and Methods: A retrospective single centre study in Ziauddin University Hospital Karachi. In one year period from January 2016-December 2016, total 280 laparoscopic cholecystectmy patients were included. Results: Total 280 patients underwent for surgery with a standard pressure pnumo-peritoneum at 12-14 mmHg in a one year period. We found 3 (1.07%) patients with shoulder tip pain. 2 were male, 1 was female with average age was 34+6.5 (range 13). All patients dealt with the proper suction irrigation and gas aspiration, abdomen pressed down for forced out gas at the end of procedure. Average pain score+SD was 8.3± 0.57 (range 1), 5.3±1.15 (range 2), 0.3+ 0.57 at 6,12 and 24 hours respectively with average time duration of surgery was 51+7.6 minutes (range 15 minutes). Conclusion: Th e shoulder tip pain aft er laparoscopic cholecystectmy is dependent on a multiple factors. Some surgical techniques and interventions can reduce pain by gas aspiration with suction irrigation. Th e pressure of pneumo-peritoneum, increase intraoperative time duration had no eff ect on the incidence or severity of shoulder tip pain. Female pre-ponderance but no role of age as a cause of shoulder tip pain. [ABSTRACT FROM AUTHOR]

Background: Carcinoid tumors are neuro-endocrine origin and appendix is one of its common sites. Carcinoid tumor of the appendix still pursue with the curiosity in spite of their low occurrence rate. Nearly all appendiceal carcinoids prett y much always silent on clinical presentation and found incidentally at histopathology. Our study focus was to present our experience clinico-pathological behavior, dissemination of tumor and treatment protocols of carcinoid tumor of appendix as managed at university teaching hospital. Material and Methods: A retrospective study of 1,406 appendectomies performed in tertiary care single centre in Ziauddin University and hospital Karachi, considered period from August 2005 to December 2016. Study of 11 patients with histo-pathologically established diagnosis of carcinoid tumor of the appendix. Reviewed the surgical records, analysis of demographic data, clinical presentation, histopathology, operative records and consequences was presented. Result: Among the 1,406 appendectomies 11(0.78%) carcinoid tumor of appendix were identifi ed, 7 (58.3%) male and 5 (41.6%) female patients. All the patients with a carcinoid tumor posed with the characteristics indicative of acute appendicitis, diagnosis established on histopathology aft er appendectomy. Additionally no more surgery was necessitated while all these tumors < 1cm and base of the appendix was not involved. Conclusion: Our data confi rmed the good prognosis as reported in literature. Nearly all carcinoid tumor of appendix frequently present as acute appendicitis. In most of the cases carcinoid found incidentally in histopathology and diagnosis is presumed seldom prior to histopathology. Carcinoid tumor of appendix can be cured by simple appendectomy if tumor size is less than 1 cm. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis of the gallbladder is an occasional and able to cured entity. Preoperative diagnosis is a great challenging task while disease has non pathognomonic clinically and radiologically. Tuberculosis of the gallbladder is still made difficult with the gallbladder malignancy and some other gallbladder lesions. Histopathology can establish the right diagnosis of this isolated tuberculous infection of the gallbladder. Our study focus is to assess the frequency rate and pre-operative clinical pathognomonic for accurate diagnosis. Methods: Data searched retrospectively and reviewed patient's record from January 2011 to June 2016 for tuberculosis of the gallbladder. Single center study conducted in Ziauddin University and hospital Karachi. In fi ve years of period we had three cases of tuberculosis of the gallbladder. Result: Retrospective analysis showed incidentally three (0.16%) cases of tuberculosis of the gallbladder out of 1,765 gallbladder specimen aft er cholecystectmy. Total female was 1,255(71.1%) and male was 510(28.8%). Female and male ratio was 1:0.4. All three (100%) patients of gallbladder tuberculosis were female with history of recurrent right upper abdominal pain, fever, nausea, vomiting and weight loss. Laparoscopic cholecystectomy performed. Diagnosis was made on histopathology. Conclusion: Th ere is no indicative sign and symptoms for preoperative diagnosis of tuberculosis of the gallbladder, usually depends on histopathology. For that reason all specimens of the gallbladder should be sent for histopathology to exhibit tuberculosis of the gallbladder in indigenous places. In spite of that post-operative proof is a pronounced catastrophe of diagnosis if acalculous cholecystitis, as a disease is treatable medically and surgery is inevitable. [ABSTRACT FROM AUTHOR]

Background: The use of quantifiable and reproducible measurement tool for pre-operative prediction of difficult laparoscopic cholecystectmy by compendious scoring method is a key for the successful pre-operative assessment and documentation of therapeutic response. Although in clinical trials have not been demonstrated for application in patients suff ering from gallstone disease. As justification we carried out a study to vindicate a pre-operative prediction of difficult laparoscopic cholecystectmy scoring tool. Methods: Th is prospective study conducted in tertiary care single center General surgery department Ziauddin University Hospital from April 2016 to August 2016. Our trial comprise of one hundred and thirty six patients. Patient's evaluation and operated by skilled surgeons. Results: As an outcome that statistically significant features are history of previous episodes of cholecystitis/pancreatitis, gallbladder status and gallbladder wall thickness for prediction of difficult cases. According to this pre-operative compendious scoring method we had p <0.001 for prediction of difficult laparoscopic cholecystectomy. Conversion fi gure was 0.7%. Conclusion: We put forward that with the use of this compendious scoring approach for pre-operative prediction may encourage to label as probably difficult and very difficult cases. A patient's situation expose to danger and possibility of conversion may be counseled. Th us the surgeon may have a possibility to bring about planning appropriately and enlightened for further complications. [ABSTRACT FROM AUTHOR]

Background: Gallbladder specimen after cholecystectomy is one of the rarely come up against in routine histopathology. Accompanied by the great supposition, nearly all gallbladder specimens harbor the benign disease, but once in a while unexpected to find malignancy. Occult gallbladder carcinoma is uncommon, highly lethal, although it is fifth prevailing malignancy in the gastrointestinal tract. Gallbladder malignancy is possible to cure if diagnosed at early stage and promptly treated surgically. Aim of study to figure out the occurrence of incidental carcinoma of the gallbladder and its curative options after elective cholecystectomy detected in routine histopathology. Methods: Cohort study was done in total 1522 specimens of gallbladder, that were submitted in the pathology department in Ziauddin University and Hospital, five years of duration from Jan 2011 to Dec 2015, that were searched retrospectively for incidence of occult gallbladder carcinoma. Result: We found 16(1.05%) cases of occult gallbladder carcinoma out of 1,522 patients, 4(25%) well differentiated, 9(56.25%) moderately differentiated, 2(12.5%) poorly differentiated and 1(6.25 %) was undifferentiated adenocarcinoma. The incidence rate of primary malignancy was 1.05% and commonly found in female with the complete number of laparoscopic cholecystectomies carried out in that time. During follow up two patients lost, rest of the patients no recurrence or metastasis seen at 6, 12 and 24 months but one patient still not completed two years follow up. Conclusion: Gallbladder malignancy may be curable if diagnosed in early stages. Laparoscopic cholecystectomy may not worsen the prognosis in such cases. Therefore every gallbladder specimen should be examined histopathologically after cholecystectomy to detect possible occult gallbladder carcinoma. [ABSTRACT FROM AUTHOR]