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Background: Majority of surgeons place a drain following thyroid surgery to evacuate collected blood and serum. The aim of this study was to compare the outcome of thyroid surgery with and without drainage. Material & Methods: This randomized clinical trial was conducted at Surgical Department, Jinnah Postgraduate Medical Centre and Dow University Hospital, Karachi from August 2013 to January 2014. Inclusion criteria were age between 18-65 years, either gender, solitary thyroid nodule with maximum size 3x3 cm, ASA physical status I and II, euthyroid patients undergoing thyroidectomy and duration of disease >6 months. Exclusion criteria were bleeding diathesis, multinoduler goiter, thyroid cancer, previous thyroid surgery and anticoagulant therapy. In group A drain was placed and in group B no drain was placed. Pain score on first postoperative day and duration of hospital stay were noted on visual analog scale (VAS). Results: In Group A the median IQR of postoperative hospital stay was 2(1-2) and in Group B 1(1-1). In Group A the median IQR of pain on 1st postoperative day on VAS was 2(2-3) and in Group B 1(1-1). Pain was observed in Group A in 6.7% patients VAS score 1, in 53.3% patients 2, in 36.7% patients 3 and in 3.3% patients 4. In Group B 83.3% patients had VAS score 1, 13.3% had 2, 3.3% had 3 and 0% VAS score 4. In group A 36.7% patients were discharged on 1st postoperative day, 53.3% on 2nd and 10.0% on 3rd postoperative day. In Group B 93.3% patients were discharged on 1st postoperative day, 6.7% on 2nd and 0% on 3rd postoperative day. Conclusion: Routine drainage of thyroidectomy bed is unnecessary after uncomplicated thyroid surgery, as it is not effective in decreasing the rate of postoperative complications resulting from post thyroidectomy haemorrhage. [ABSTRACT FROM AUTHOR]

Objective: To assess various intra operative predictive factors which are reponsible for difficulty in performing laparoscopic cholecystectomy. Study Design: Prospective observational study. Place and Duration of Study: This study was out in Surgical department, Liaquat University Hospital Jamshoro, Dow International Hospital Karachi and Jinnah Postgraduate Medical Center Karachi, from October 2012 to October 2013. Methodology: This study consisted of hundred patients. Detailed History was taken from all the patients with special regard to the abdominal pain or pain in right hypochondrium, lump in right hypochondrium , vomiting , dyspepsia and fever. Detailed Clinical examination of the patient was done . Site of right hypochondrium was especially examined for assessment of murphy's sign , palpable mass , visceromegaly and recorded in proforma. Systemic review was also done to see any comorbidity. Ultrasound of abdomen as diagnostic modality and for assessment of gallstone disease. Inclusion criteria were all diagnosed patients of complicated and uncomplicated gall stone disease of any age and either any sex admitted on the basis of history , clinical examination and investigations specially ultrasound of abdomen. Exclusion criteria included unfit patients for general anesthesia , Pregnant ladies due to risk of foetal loss, patient with carcinoma of gall bladder , patient with acute pancreatitis and Patient with obstructive jaundice. Follow up of all these patients was done. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. Results: Out of 100 patients included in this study 79 were female (79%) and 21 male (21%); with female to male ratio of 3.76:1. There was wide variation of age ranging from a minimum of 20 years to 65 years . The mean age was 46.28+7.20 years. Symptoms of patients presented with pain in RHC 87% , pain in RHC along with pain in epigastrium 78%, Nausea & Vomiting 15%, dyspepsia 50% and fever in 10% of cases. Ultrasound examination revealed single stone in 20(20%) patients where as multiple stones in 80(80%) patients. Operative findings revealed severe adhesions in calot's triangle in 15(15%) patients where as Severe & tight adhesions around gallbladder in 16(16%) patients, Obscured anatomy in calot's triangle in 11(11%) patients and Intrahepatic gallbladder in 9(9%) patients. Complications were Pain in 33(33%) patients, Bleeding in 1(1%) patients, Intraperitoneal collection in 2(2%) patients, Wound Sepsis in 5(5%) patients and Biliary leakage in one case. Conclusions: In conclusion our study revealed that are numerous conditions which make the difficult laparoscopic cholecystectomy like severe adhesions in calot's triangle 15%, Severe & tight adhesions around gallbladder 16%, Obscured anatomy in calot's triangle 11%, Intrahepatic gallbladder 9% and adhesions around gallbladder 26%. [ABSTRACT FROM AUTHOR]

Objective: Fast ultrasound is a basic tool to evaluate the blunt abdominal trauma patient and help to decision making for emergency surgery. Study design: Observational study. Place and duration of study: The King Fahad Hospital Madina Munawara, over a period between 2010 and 2011. Methodology: This study consisted of 765 patients came in Emergency department The King Fahad Hospital Madina Munawara Level II, or Regional Resource Trauma Center Saudi Arabia. Detailed History was taken from all the patients with special regard to bland abdominal trauma. All patients were brought to a trauma resuscitation area where a trauma team conducted a primary survey, after an airway and adequate oxygenation/ventilation were established. The FAST examinations were performed using 4 windows: subxiphoid, right upper quadrant, left upper quadrant, and suprapubic. The critical areas for intra-abdominal bleeding were the hepatorenal space (Morrison's pouch), the spleno-renal space, and the pelvic pouch of Douglas. The FAST examinations were interpreted on the spot and results Recorded. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. Results: 73 out of 765 patients who underwent FAST ultrasound in the Emergency Room. 40 (54.79%) cases were road traffic accident (RTA) injuries followed by injury due to fall were in 33(45.20%) cases. Findings are fast ultrasound observed 49 out of 73 patients (67.12%) were considered positive FAST who had fluid (blood) in the peritoneal cavity and these patients shift to Operative Room for surgery. While 24(32.87%) patients with no evidence of intraperitoneal fluid were considered negative for FAST and these patient underwent CT scans for evidence of solid organ injury(Chart No.2). 5 out of 24 cases of solid visceral trauma found on CT scan abdomen, but had not been detected by FAST then shift to operative room after resuscitation. Conclusions: We conclude that FAST ultrasound is very helpful to assessment of blunt abdominal trauma and to detect intraabdominal fluid. Fast ultrasound can help in the quick decision for surgical intervention within minutes of a patient's arrival at emergency department. [ABSTRACT FROM AUTHOR]