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Papers by Irfan Khattak
J Ayub Med Coll …, 2008
Background: Carcinoma of the prostate is one of the common tumours of old age in men. This cross ... more Background: Carcinoma of the prostate is one of the common tumours of old age in men. This cross sectional study was conducted to detect carcinoma of prostate in clinically benign enlarged gland and to evaluate the efficacy of Digital rectal Examination in detection of prostatic cancer in patients presented at Khyber Teaching Hospital, Peshawar from July 1998 to July 1999. Methods: Patients presenting with lower urinary tract symptoms over the age of 50 years were evaluated on English version of International Prostate Symptoms Score (IPSS), clinically examined and post-voiding residual urine determined on abdominal sonography. The selection criteria were; Severe IPSS, absence of signs of malignancy on Digital Rectal Examination (DRE) and post-voiding residual urine more than 100 ml. Thus a total 100 patients were selected for further study. Four ml blood was taken to assess Prostate Specific Antigen (PSA) level pre-operatively. All these patients underwent either transvesical prostatectomy or transurethral resection of prostate (TURP) and enucleated prostatic tissues were sent to histopathology. Results: Eighty-five percent patients had PSA level up to 10 ηg/ml. PSA level of 15 (15%) patients were above 10n gm/ml out of which 13 (13%) patients were having PSA in range of 11-12 ηg/ml and two (2%) had PSA level between 20-25 ηg/ml. Histopathology report of 2% patients turned out as adenocarcinoma of the prostate. Conclusion: Out of 100 patients who were having clinically benign DRE findings, 2 turned out as Carcinoma of the prostate histologically.
Australian and New …, 1998
Background: To establish the incidence, timing and outcome of peritonitis following percutaneous ... more Background: To establish the incidence, timing and outcome of peritonitis following percutaneous gastrostomy (PEG) insertion in children.Methods: Patients developing peritonitis after PEG insertion during a 5-year period (1990–95) were identified. Variables analysed included clinical presentation, management, operative findings and outcome.Results: One hundred and twenty paediatric patients received 130 PEG in the 5-year period. Eight children developed peritonitis: 4 within 24 h of PEG insertion and 4 following routine PEG tube change (3–18 months later). All four patients developing early peritonitis underwent laparotomy in whom three had sustained major damage to adjacent viscera. The fourth patient had a negative laparotomy, but died from continued overwhelming sepsis. All four patients who developed peritonitis after a routine tube change underwent a tube contrast study. In two children a gastrocolic fistula was identified and surgically repaired. Contrast studies in two patients detected an intraperitoneal leak. This problem resolved with conservative management in both cases.Conclusions: Peritonitis immediately following PEG insertion is rarely due to the air leakage during insertion (benign pneumoperitoneum) and warrants early laparotomy to identify and correct the likely associated visceral trauma. Following PEG tube change peritonitis may result from stomal separation or tube malposition and an urgent study is indicated to identify the cause.
Journal of Pediatric Surgery, 1998
Purpose: The aim of this study was to establish the morbidity and mortality of percutaneous endos... more Purpose: The aim of this study was to establish the morbidity and mortality of percutaneous endoscopic gastrostomy (PEG) in a tertiary referral paediatric practice and to identify risk factors for developing complications after a PEG.Methods: The medical records of all patients who had a percutaneous endoscopic gastrostomy attempted over a 5-year period (1990 to 1995) were reviewed.Results: One hundred thirty percutaneous gastrostomies were placed in 120 paediatric patients. Indications for insertion were inability to swallow (n = 74, of which, 52 were neurologically impaired), inadequate calorie intake (n = 30), special feeding requirements (n = 12), continuous enteral feeding in short gut (n = 2), and malabsorption (n = 2). All the children had complex medical problems, and 80% of the patients were rated as “high risk’ for general anaesthesia (≥ASA grade 3). Major complications developed in 21 children (17.5%) and minor complications in 27 (22.5%). Of the 17 children in whom gastroesophageal reflux (GOR) became symptomatic, 10 required a Nissen fundoplication. Nine of these 10 children were neurologically impaired (19% of the neurologically impaired children). One postrenal transplant patient on immunosuppression died 54 days after the procedure of intraabdominal sepsis. Thirty-one patients required secondary surgical procedures.Conclusions: PEG is associated with significant morbidity. Neurologically impaired children are at risk of acquiring symptomatic GOR, but the risk does not warrant routine fundoplication. Major complications are common and need urgent surgical consultation with many requiring secondary surgical procedures. PEG in paediatric patients should be considered a major surgical undertaking.
J Ayub Med Coll …, 2008
Background: Carcinoma of the prostate is one of the common tumours of old age in men. This cross ... more Background: Carcinoma of the prostate is one of the common tumours of old age in men. This cross sectional study was conducted to detect carcinoma of prostate in clinically benign enlarged gland and to evaluate the efficacy of Digital rectal Examination in detection of prostatic cancer in patients presented at Khyber Teaching Hospital, Peshawar from July 1998 to July 1999. Methods: Patients presenting with lower urinary tract symptoms over the age of 50 years were evaluated on English version of International Prostate Symptoms Score (IPSS), clinically examined and post-voiding residual urine determined on abdominal sonography. The selection criteria were; Severe IPSS, absence of signs of malignancy on Digital Rectal Examination (DRE) and post-voiding residual urine more than 100 ml. Thus a total 100 patients were selected for further study. Four ml blood was taken to assess Prostate Specific Antigen (PSA) level pre-operatively. All these patients underwent either transvesical prostatectomy or transurethral resection of prostate (TURP) and enucleated prostatic tissues were sent to histopathology. Results: Eighty-five percent patients had PSA level up to 10 ηg/ml. PSA level of 15 (15%) patients were above 10n gm/ml out of which 13 (13%) patients were having PSA in range of 11-12 ηg/ml and two (2%) had PSA level between 20-25 ηg/ml. Histopathology report of 2% patients turned out as adenocarcinoma of the prostate. Conclusion: Out of 100 patients who were having clinically benign DRE findings, 2 turned out as Carcinoma of the prostate histologically.
Australian and New …, 1998
Background: To establish the incidence, timing and outcome of peritonitis following percutaneous ... more Background: To establish the incidence, timing and outcome of peritonitis following percutaneous gastrostomy (PEG) insertion in children.Methods: Patients developing peritonitis after PEG insertion during a 5-year period (1990–95) were identified. Variables analysed included clinical presentation, management, operative findings and outcome.Results: One hundred and twenty paediatric patients received 130 PEG in the 5-year period. Eight children developed peritonitis: 4 within 24 h of PEG insertion and 4 following routine PEG tube change (3–18 months later). All four patients developing early peritonitis underwent laparotomy in whom three had sustained major damage to adjacent viscera. The fourth patient had a negative laparotomy, but died from continued overwhelming sepsis. All four patients who developed peritonitis after a routine tube change underwent a tube contrast study. In two children a gastrocolic fistula was identified and surgically repaired. Contrast studies in two patients detected an intraperitoneal leak. This problem resolved with conservative management in both cases.Conclusions: Peritonitis immediately following PEG insertion is rarely due to the air leakage during insertion (benign pneumoperitoneum) and warrants early laparotomy to identify and correct the likely associated visceral trauma. Following PEG tube change peritonitis may result from stomal separation or tube malposition and an urgent study is indicated to identify the cause.
Journal of Pediatric Surgery, 1998
Purpose: The aim of this study was to establish the morbidity and mortality of percutaneous endos... more Purpose: The aim of this study was to establish the morbidity and mortality of percutaneous endoscopic gastrostomy (PEG) in a tertiary referral paediatric practice and to identify risk factors for developing complications after a PEG.Methods: The medical records of all patients who had a percutaneous endoscopic gastrostomy attempted over a 5-year period (1990 to 1995) were reviewed.Results: One hundred thirty percutaneous gastrostomies were placed in 120 paediatric patients. Indications for insertion were inability to swallow (n = 74, of which, 52 were neurologically impaired), inadequate calorie intake (n = 30), special feeding requirements (n = 12), continuous enteral feeding in short gut (n = 2), and malabsorption (n = 2). All the children had complex medical problems, and 80% of the patients were rated as “high risk’ for general anaesthesia (≥ASA grade 3). Major complications developed in 21 children (17.5%) and minor complications in 27 (22.5%). Of the 17 children in whom gastroesophageal reflux (GOR) became symptomatic, 10 required a Nissen fundoplication. Nine of these 10 children were neurologically impaired (19% of the neurologically impaired children). One postrenal transplant patient on immunosuppression died 54 days after the procedure of intraabdominal sepsis. Thirty-one patients required secondary surgical procedures.Conclusions: PEG is associated with significant morbidity. Neurologically impaired children are at risk of acquiring symptomatic GOR, but the risk does not warrant routine fundoplication. Major complications are common and need urgent surgical consultation with many requiring secondary surgical procedures. PEG in paediatric patients should be considered a major surgical undertaking.