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Arshad Zafar

Publications and source records attributed to Arshad Zafar.

7 recordsLinked to original sources
PubMed2003

Small bowel obstruction in children due to persimmon phytobezoars.

OBJECTIVE: To present the clinical picture of small bowel obstruction caused by Persimmon phytobezoars in children of Hazara (Northern Pakistan). DESIGN: Descriptive case series. PLACE AND DURATION OF STUDY: Three general surgical units of Ayub Teaching Hospital, Abbottabad from November 1998 to March 2003. PATIENTS AND METHODS: Nineteen children were managed for small bowel obstruction due to persimmon phytobezoars. The age, gender, season at the time of presentation, history of persimmon ingestion, symptoms, signs, site of obstruction, operative procedure and outcome were analyzed. RESULTS: There were 15 males and 4 females with ages ranging from 4-11 years (mean 7 years). All presented in winter with a positive history of persimmon ingestion. All had signs and symptoms and evidence of small bowel obstruction on plain abdominal x-rays. At laparotomy, ileum was the commonest site of obstruction. Milking of bezoars into caecum was performed in 17 patients while 2 patients required enterotomy for removal of bezoars. Complications occurred in 4 patients. There was no mortality. CONCLUSION: Small bowel obstruction in children due to persimmon phytobezoars is uncommon. However, it should be considered pre-operatively as a possible cause of intestinal obstruction in winter in children who have access to the fruit. Laparotomy should be performed for persistent obstruction or signs of strangulation.

Bezoars↗
PubMed2003

Gastrointestinal perforation in children due to blunt abdominal trauma in Hazara, Northern Pakistan.

A retrospective study of 25 children with gastrointestinal perforation due to blunt abdominal trauma in a single region of Pakistan is presented. The age, sex, aetiology, site of perforation, abdominal and X-ray findings, associated injuries, surgical procedures and outcome were analysed. There were 20 boys and 5 girls: mean age was 10 years. The injuries were the result of road traffic accidents 12 (48%), falls 11 (44%) and 'struck by animals' two (8%). Associated injuries occurred in 19 (76%). On admission 20 (80%) patients had peritonitis while 18 (72%) had pneumoperitoneum. Mean time from trauma to admission was 10 hours and admission to operation was 5 hours. Ileum was the most common site of perforation. Simple closure was the most common surgical procedure. Complications occurred in nine (36%) patients--six (24%) died. Delay in presentation and operation was associated with increased morbidity and mortality. Frequent evaluation of the child and abdominal X-rays are still the important tools for early diagnosis of gastrointestinal perforation following blunt abdominal trauma.

Abdominal Injuries↗
PubMedDate not supplied

Amoebic liver abscess: a comparative study of needle aspiration versus conservative treatment.

BACKGROUND: Amoebic liver abscess is a serious problem in Pakistan. Its management includes antimicrobial drugs, needle aspiration and surgical drainage. This study was done to see the therapeutic efficacy, safety and outcome of ultrasound guided needle aspiration of amoebic liver abscess combined with antiamoebic drugs. METHODS: This was a prospective study with a minimum follow up of six months comparing the results of needle aspiration plus antiamoebic drugs with drug treatment alone in Amoebic Liver Abscess. It was carried in Surgical 'B' Unit of Ayub Teaching Hospital from July 1998 to June 2001. The patients were divided into two groups. Group A with abscess < 300 cm3 were treated with drugs alone. Group B patients with abscess > 300 cm3 or smaller abscesses which failed to respond to medical treatment were treated with both needle aspiration and drugs. Main outcome measures were abdominal pain, fever, anorexia, hepatomegaly, resolution of amoebic liver abscess on ultrasound, length of hospital stay and any complications. RESULTS: There were 46 patients in the study group. 21 (45.5%) patients were in Group A and 25 (54.5%) in Group B. The ages ranged from 15-70 years. 38 patients were male and 8 were females. The right lobe was involved in 44 (95.5%) patients and left lobe in 2 (4.5%) patients. Mean volume of abscess in Group A was 225 cm3 and in Group B was 560 cm3. Needle aspiration was successful in 24 (96.3%) patients and failed in 1 (3.7%) patient. The mean time of clinical improvement was 7 and 3 days respectively in Groups A and B. The mean hospital stay was shorter in Group B (3.5 day) than Group A (7.5 days). The resolution of abscess seen on ultrasound was rapid in Group B. Complications occurred in only one patient in Group B. No mortality was seen in any group. CONCLUSIONS: Needle aspiration combined with antiamoebic drugs is more effective than drug treatment alone in the management of amoebic liver abscess.

Adolescent↗
PubMedDate not supplied

An audit of patients' satisfaction after adult day-case surgery at Ayub Teaching Hospital, Abbottabad.

BACKGROUND: Day-case surgery has become an important component in the provision of surgical care in the Western countries. This study was done to introduce the concept of day-case surgery and assess the patients' satisfaction after day case general surgery in our set up with vast rural communities lacking medical facilities and no day-case surgery units in the hospitals. METHODS: All those patients suitable for day-case surgery and who accepted day-case surgery for general surgical procedures in General Surgical 'A' unit of Ayub Teaching Hospital, Abbottabad were interviewed after the operation on follow up visits. Questions were asked about their satisfaction with day-case surgery. If they were not satisfied, the reasons for dissatisfaction were noted. Direct admissions and re-admissions after day-case surgery were recorded. Any complications in the postoperative period were also noted. The patient's preference for a similar procedure as day-case in future was also recorded. RESULTS: There were 122 patients in this study. 60(49%) were operated under general anesthesia and 62(51%) under local anesthesia. Fourty Nine (40%) patients were satisfied while 73(60%) were not satisfied with day-case surgery. Six (5%) patients were admitted directly after day-case surgery while 7(5.7%) patients were admitted after discharge. Complications occurred in 41(33.6%) patients at home. Wound complications and pain were the most common morbidity encountered by the patients. Twenty eight (23%) patients contacted a hospital or a doctor in the early postoperative period. Sixty two (51%) patients would prefer operation as in-patient while 74 (60.6 %) would prefer an overnight stay after the operation next time. CONCLUSIONS: Patients' satisfaction with day-case surgery in Ayub Teaching Hospital is not high. Short-stay surgery would be more appropriate in our set up.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Accuracy of surgeon-performed abdominal utrasound for gallstones.

BACKGROUND: Gallstone disease is common in Pakistan. It is primarily diagnosed by ultrasonography. which is traditionally done by radiologists. If surgeons could perform ultrasonography, it would enable early diagnosis in one-stop clinic. This study was done to evaluate the accuracy of surgeon-performed abdominal ultrasonography to detect gallstones. METHODS: This study was carried out at Surgical A and Surgical C units of Ayub Teaching Hospital, Abbottabad from July, 2000 to December, 2002. One hundred fourty two patients with signs and symptoms of gallstone disease who had ultrasonography performed by a surgeon. trained in ultrasonography were exclusively studied. These patients were referred for further scanning by the radiologists who were unaware of the surgeon's interpretation. The results of surgeon and radiologist performed ultrasonography were compared. RESULTS: The interpretation of surgeon-performed ultrasonography was correct in 100 patients and incorrect in 42 patients. There were 100 True Positive, 41 True Negative, One False Negative and Zero False Positive scans yielding 99%, Sensitivity, 100% Specificity and 99.3%, Accuracy. Sensitivity of surgeon-performed ultrasonography in detecting gallstones compared to operative findings was 100%. CONCLUSIONS: Abdominal ultrasonography performed by an ultrasonography trained surgeon can detect gallstones as accurately as by a radiologist.

Adult↗
PubMedDate not supplied

Combined abdominal hysterectomy, cholecystectomy and appendicectomy: a study of 25 cases in Abbottabad.

BACKGROUND: Gallstone disease is common in women. Many patients undergoing abdominal ultrasound for gynaecological diseases are found to have gallstones. This study was done to see the results of combined abdominal hysterectomy, mini-cholecystectomy and appendicectomy in a set up lacking facilities of laparoscopic surgery. METHODS: This prospective study was conducted in Ayub Teaching Hospital, Iltaf Hospital and Shahina Jamil Trust Hospital of Abbottabad from August 1998 to July 2004. All patients undergoing combined abdominal hysterectomy and mini-cholecystectomy were exclusively studied with reference to following variables. Age, Weight, Parity, Co-morbid conditions, peri-operative and post-operative complications, blood transfusion, hospital stay and mean extra time for mini-cholecystectomy and appendicectomy after abdominal hysterectomy. RESULTS: There were 25 patients in the study group. The ages ranged from 35-50 years. Mean weight was 65 Kg. There were no operative complications. Mild postoperative complications occurred in 7(28%) patients. Mean extra time for cholecystectomy was 25 minutes. Mean hospital stay was 9 days. CONCLUSIONS: In selected women, combined abdominal hysterectomy, cholecystectomy and appendicectomy is a safe, feasible and cost effective procedure.

Adult↗