Journal of the College of Physicians and Surgeons--Pakistan : JCPSP最新文献

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Objective: To determine the clinical effectiveness of different green tea extracts (GTEs) in reducing bleeding after extraction of mandibular molars.

Study design: Randomised controlled trial. Place and Duration of the Study: College of Dentistry, King Khalid University, Abha, Saudi Arabia, from October to December 2022.

Methodology: A total of 64 patients were selected from those who attended dental clinics at the College of Dentistry, King Khalid University for extraction of their mandibular molars. They were equally and randomly divided into a control and three test groups by asking the patient to choose a numbered piece of paper. In the first group, normal saline-soaked sterile gauze was used after the tooth extraction while in the three test groups, different GTEs (methanolic GTE, aqueous GTE, and tannin isolated from the green tea) were applied. Monitoring of the bleeding by observing the extraction socket was carried out at regular intervals of five minutes until the oozing subsided, and then once an hour after that.

Results: Each group had 16 patients. The mean of bleeding stop-minutes was significantly different among the groups (61.56 minutes for the control group, 7.50 minutes 8.44 minutes and 5.62 minutes for the test groups, p <0.001). The median of bleeding stop-minutes of the control group was significantly higher than all test groups (p <0.001). The number of patients in whom bleeding was continued one hour after surgery was significantly higher in the control group (p = 0.005). Moreover, tannin has the greatest haemostatic effect compared to aqueous and methanolic GTEs.

Conclusion: Significant haemostatic effect has been shown by all GTEs. Tannin isolated from green tea has shown a significantly higher haemostatic effect than to the aqueous and methanolic extracts.

Key words: Bleeding, Green tea extracts, Haemostasis, Tannin isolate, Molar extraction.

Objective: To determine the frequency and types of congenital anomalies of the kidney and urinary tract (CAKUT) in patients with Hirschsprung disease.

Study design:  An observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery, National Institute of Child Health, Karachi, Pakistan, from June to December 2022.

Methodology: All patients with biopsy-proven Hirschsprung disease were included. Ultrasound was done to find out the anatomical and structural anomalies of the kidney and urinary tract. Functional assessment was done by renal function tests and MAG3 radioisotope scan where indicated. Fisher's exact test was applied to find out the association. A p ≤0.05 was taken as significant.

Results: Out of a total of 83, 15 (18.0%) patients had CAKUT. The mean age of the study population was 5.5 ± 2.3 years. It included 61 (73.5%) males and 22 (26.5%) females. No significant association was found between the type of Hirschsprung disease and CAKUT (p = 0.7). The gender distribution between CAKUT patients was also insignificant (p = 0.7). Renal hypoplasia was the most common anomaly found in six patients followed by hydronephrosis due to pelvi-ureteric junction obstruction in four children. All of these children were asymptomatic. Five male patients had undescended testis.

Conclusion: Nearly a fifth of the children with Hirschsprung disease had CAKUT of whom renal dysplasia was the most common anomaly. There was no gender predilection and patients were asymptomatic regarding the urinary system. A routine ultrasound abdomen is a good screening investigation for identifying CAKUT.

Key words: Hirschsprung disease, Kidney and urinary tract, Congenital diseases of the urinary tract, Congenital anomalies.

The aim of this study was to perform histopathological analysis of residual material in the cannula by endometrial sampling using a Carmen injector, and to compare the results. The study was conducted in the Department of Gynaecology, Mardin Training and Research Hospital, Artuklu/Mardin, Turkiye, from December 2021 to June 2022. The study group consisted of 104 patients who presented to the outpatient clinic with complaints of abnormal uterine bleeding. Endometrial curettage material was collected from all patients using a Carmen injector. The collected material was discharged into the pathology container (Group 1). Subsequently, the residual material remaining in the injector was placed in a separate pathology container (Group 2). Specimens were sent to the pathology laboratory with buffered formol. The pathological evaluation was performed by the same pathologist without revealing the patients' names. Comparative histopathological results of the patients in Group 1 and Group 2 were found to be fully compatible in 64.4% of the patients. In 35.6% of the patients, the histopathological results were different from each other between Group 1 and Group 2. Pathological results were different from each other in 21.2% of patients with incompatible pathology results. In Group 1, 16.7% of the patients were over-diagnosed, while 7.7% of the patients were over-diagnosed in Group 2. It would be beneficial to carefully remove the material remaining in the cannula and send it for pathological examination as it may affect the histopathological results. Key Words: Abnormal uterine bleeding, Probe curettage, Karman cannula, Histopathological evaluation.

Objective: To compare the radiological peritoneal cancer index (PCI) score to the surgical PCI score for validating it as a non-invasive method to predict surgical outcomes.

Study design: A descriptive study. Place and Duration of the Study: Department of Obstetrics and Gynaecology of the Aga Khan University Hospital, Karachi, Pakistan from September 2021 to May 2022.

Methodology: All successive patients diagnosed with advanced-stage ovarian cancer were enrolled in the research. Prior to surgery, the severity of ovarian cancer was evaluated using the Sugarbaker Peritoneal Cancer Index score derived from radiological imaging. The score was compared to the surgical PCI score determined during the surgery. The correlation between the scores and residual tumour status was confirmed.

Results: The study included a total of 26 patients. The mean age of patients was 50.17 years, with a standard deviation of 11.04. Five (19.2%) patients underwent surgery first, whereas 21(80.8%) needed interval debulking surgery after receiving chemotherapy in the neoadjuvant setting. The interclass correlation value among radiological and surgical (PCI) was 0.52, with a 95% confidence interval ranging from 0.17 to 0.75. The Bland-Altman plot displays the agreement amongst the PCI scores, indicating a bias of 1.115 with a 95% confidence interval of 4.61. Surgical exploration revealed zero residual disease in 90% of persons with a PCI score <10. Patients with a PCI score <10 had significantly brief operative time and reduced blood loss compared to those with a score >10. Patients with a PCI score below 10 had also fewer complications.

Conclusion: PCI is an efficient means for anticipating the success of surgery and the existence of residual disease without invasive measures. This can be very helpful in deciding the best time for surgery.

Key words: Peritoneal cancer index, Advanced ovarian cancer, Carcinomatosis, Prognosis, Tumour load.

Objective: To assess the impact of post-protamine neutralisation activated clotting time (ACT) values on postoperative outcomes including chest drain output, transfusion requirements, and CICU stay, in patients undergoing cardiac surgery.

Study design: Observational comparative study. Place and Duration of the Study: Department of Anaesthesiology, The Aga Khan University Hospital, Karachi, Pakistan, from February to August 2023.

Methodology: Ethical approval was obtained to collect data from elective cardiac surgery patients' charts. A sequential sampling approach analysed the baseline and post-protamine neutralisation ACT values, categorising patients into two groups. Group A maintained ACT within 10% of baseline, while Group B deviated. The outcomes measured included transfusion needs, chest drain output, additional protamine, cardiac intensive care unit (CICU) stay, and postoperative reopening. Statistical analysis included mean, median, frequency, t-test / Mann-Whitney U test, and Chi-square test.

Results: The study comprised 101 patients (39 in Group A, 62 in Group B), with similar baseline health. No significant differences were found in tranexamic acid use, CICU stay, chest drain output, or transfusion rates between the groups (p >0.05).

Conclusion: Maintaining ACT within 10% of baseline post-protamine neutralisation results in similar intraoperative and postoperative outcomes, suggesting potential benefits in avoiding the aggressive protamine therapy and ensuring haemostasis in cardiac surgery.

Key words: Coronary Artery bypass grafting, Cardiopulmonary bypass, Activated clotting time (ACT), Heparin, Postoperative bleeding, Blood transfusions.

Objective: To assess the results of double-face buccal mucosal graft urethroplasty (BMG) for treating anterior urethral stricture in adult males.

Study design: An observational study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from 2021 to 2022.

Methodology: The inclusion criteria were adult males, aged 15 to 70 years, with a previous surgical procedure for hypospadias and the presence of long penile and bulbar strictures measuring over 2 cm, resulting from a straddle injury. Forty-three patients were selected who underwent urethroplasty in 2021 and completed a one-year follow-up in 2022. Uroflowmetry (UFM) and the International Index of Erectile Function (IIEF) assessment data were obtained from the patients' medical records. Success was defined as the patient attaining catheter freedom and achieving a maximum flow rate exceeding 15 ml/sec after one year.

Results: The mean UFM at one year was 20.89 ml/s. Four patients underwent endo-urological intervention (direct visual internal urethrotomy), and one patient needed a second double-face urethroplasty. After one year, the double-face BMG urethroplasty achieved an overall success rate of 88.4%.

Conclusion: Double-face BMG urethroplasty is a reliable and effective surgical technique for the treatment of near obliterative or obliterative long anterior urethral strictures.

Key words: Buccal mucosal graft urethroplasty, Direct visual internal urethrotomy, Anterior urethral stricture, Buccal mucosal graft, Urethral dilatation.

The aim of this study was to explore the efficacy and safety of Trastuzumab-Deruxtecan (T-DXd) in metastatic breast cancer (mBC). This retrospective observational study was conducted between January 2021 and 2023. Patients' clinical and pathological characteristics and previous medicinal treatments were reviewed. The efficacy of T-DXd and its influencing factors, as well as the adverse reactions of T-DXd were also observed. The median age of the patients was 43 years, and the median number of treatment lines was 4. In the overall population, the objective response rate (ORR) was 72.7%, the disease control rate (DCR) was 90.9%, and the median progression-free survival (mPFS) was six months. Among them, two patients temporarily discontinued treatment after two cycles of T-DXd due to financial reasons, but their disease remained stable for 5 and 8 months, respectively. Efficacy was better in patients with HER-2 amplification, who had not previously used antibody drug conjugates (ADC) drugs, were sensitive to anti-HER-2 treatment, and had ≤3 lines of therapy. Common adverse reactions during T-DXd treatment included gastrointestinal reactions such as nausea, vomiting, diarrhoea, and constipation, as well as haematological toxicities, decreased appetite, hair loss, and fatigue. Some patients experienced gastritis, abnormal liver function, and weight gain, but none of the patients developed interstitial pneumonia. T-DXd can achieve significant and durable survival benefits with controllable safety in patients with HER2-positive or HER2 low-expressing mBC. Key Words: Metastatic breast cancer, Trastuzumab-Deruxtecan, Efficacy, Safety.

Objective: To determine the diagnostic value of conventional ultrasound combined with S-Detect and elastic imaging technology in differentiating between benign and malignant breast nodules.

Study design: Observational study. Place and Duration of the Study: Department of Ultrasound Imaging, Yichang Central People's Hospital, Yichang, China, from October 2019 to October 2022.

Methodology: The study included all breast nodules diagnosed using ultrasound, with patients undergoing conventional ultrasound for BI-RADS classification, elasticity score, and S-Detect examination. Benign and malignant breast nodules were classified according to the three tests and their combinations. The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under curve (AUV) of those alone and combinations were calculated and compared.

Results: Of the three methods, BI-RADS, elasticity score, and S-Detect, BI-RADS had the highest accuracy (89.29%), elasticity score had the highest specificity (96.20%), and S-Detect had the highest sensitivity (93.92%). The accuracy of combined groups were higher than that of the single group. When combined with elasticity score, the AUC of the new BI-RADS increased from 0.882 to 0.917 (p <0.001); and combined with S-Detect, the AUC of the new BI-RADS increased from 0.882 to 0.927 (p <0.001).

Conclusion: The combination of conventional ultrasound BI-RADS classification with elasticity score or S-Detect technology has a higher diagnostic efficacy for breast nodules, which can improve breast cancer detection and provide valuable diagnostic evidence for clinical practice.

Key words: S-Detect technology, Ultrasound elastic imaging, Elasticity scoring, Elasticity strain ratio value, Breast tumour.