Fracture neck of femur; avascular necrosis with cannulated screws

Fracture neck of femur is a devastating injury. One of its main complications is avascular necrosis [AVN] of the femoral head. For the fixation of femoral neck fractures, cannulated screws are now universally used. The aim of the study was to determine the frequency of avascular necrosis in fracture neck of femur fixed with cannulated screws. Descriptive cross sectional study. Orthopedic unit of Ayub Teaching Hospital Abbottabad. 7[th] March, 2011 to 6[th] September, 2011. Recruiting 113 patients of either gender between 15 to 60 years of age with fracture neck of femur who were fixed with cannulated screws. The data was entered and analyzed with the help of SPSS 10. There were 113 patients with an overall mean age of 43.51 years +/- 11.94SD. Maximum number of patients was 56 [49.50%] from the age group of 46 to 60 years. Avascular necrosis was noted in 23 [20.35%] cases. The maximum number of patients with avascular necrosis was 13 [56.52%] belonging to the age group of 15 to 25. Avascular necrosis was high in younger ages in displaced fractures of neck of femur treated with cannulated screws

External fixator in the treatment of open fractures of tibia

To evaluate the outcome of external fixator used as a definitive mean of fixation in open fracture of tibia. This cross sectional study conducted at Orthopaedics Unit District Headquarter Hospital Timergara from December 2005 to September 2008 included 40 patients with grade II, grade IIIA and IIIB open fractures of tibia. Patients with grade I, grade IIIC open fractures and the patients who needed amputation for their injuries were excluded from the study. Patients with insufficient follow up were also excluded. In all these patients an aggressive approach of early initiation of treatment, radical debridement and irrigation was adopted. All the fractures were stabilized with AO external fixator, and early soft tissue coverage was provided in these patients. On removal of the external fixator Sarmiento functional brace was used till the time of union in all these patients. The mean age of the sample was 28.80 +/- 9.87. The most common mechanism of injury in these 40 patients was road traffic accidents. Pin tract infection the commonest complication, noted in 10[25%] patients, deep wound infection in 4[10%] patients, delayed union in 4[10%] patients, and mal union, non union in none of them. Dynamisation of the fixator was done in 12[30%] patients and prophylactic bone grafting was performed in 4[10%] patients. The average time of fracture consolidation was 18 weeks. External fixator can be effectively used as definitive mean of fixation in open fractures of tibia with extensive soft tissue damage

Anatomical position of appendix in emergency care patients

To identify the anatomical position of the appendix in patients presenting at the emergency surgical ward, Lady Reading Hospital Peshawar. This descriptive study was conducted in surgical 'A' Unit, Lady Reading Hospital, Peshawar from January to June 2008. Patients coming to emergency surgical ward were examined after detailed history and investigation; and then operated. Position of appendix along with other findings was noted. 100 patients were admitted and examined. 68% were male and 32% were female. During surgery retrocaecal position was the most common [78%] followed by pelvic position in 16% of patients. Perforated appendix was observed in 06% [all retrocaecal appendixes]. Retrocaecal appendix was the commonest in patients presenting to emergency with acute appendicitis. Less symptoms/signs lead to delay in diagnosis and complications

Per-operative findings and post-operative complications with laparoscopic appendicectomy

To study the per-operative findings and post-operative complications that arise with laparoscopic appendicectomy. Material and Methods: This descriptive study was conducted in Surgical "A" and Surgical "C" Unit of PGMI, Lady Reading Hospital from April 2006 to December 2008. Patients with acute appendicitis, short history, age ranges from 15 to 50 years and recurrent appendicitis were included in this study, while patients with appendicular mass, appendicular abscess, pregnancy and with previous abdominal surgery were excluded. All the data was collected by using a proforma. Data was analyzed by descriptive statistics. Out of 60 patients admitted for Laparoscopic Appendicectomy [LA], 36[60%] were males and 24[40%] were females. Only 6[10%] patients required conversion from laparoscopic to open surgery. Problems and per-operative complications were encountered in 9[15%] patients. These were dense adhesions due to inflammation 4[6.66%], localized perforation 2[3.33%], diffuse peritonitis 2[3.33%] and bleeding during procedure 1[1.66%]. Postoperative complications were seen in 5[8.33%] cases, out of which 2[3.33%] patients developed port site infection, 1[1.66%] patient developed postoperative ileus, 1[1.66%] patient developed partial bowel obstruction and 1[1.66%] patient presented with right iliac fossa abscess. There was no mortality. All patients resumed normal activity within 6-7 days of operation and were well satisfied up to median follow-up of 5-6 months. Majority of the patients were males. Per-operative findings were adhesions, perforation and peritonitis. Post-operative complications were port-site infection, ileus and bowel obstruction. Majority recovered within a week time

Experience with the surgical management of fracture penis

To know the etiology, complications and outcome of surgical management of fracture penis. This descriptive study carried out in the surgical departments of Lady Reading Hospital Peshawar from April 2000 to March 2005. Patients with the clinical diagnosis of fracture penis were admitted and operated. All patients except those with haematuria were catheterized. Most of these patients were explored via a circumcoronal incision and the defect in the tunica of corpus cavernosum repaired with 3/0-vicryl suture. No drain was used and a light compression dressing was done in all patients. Catheter was removed on the second postoperative day. Follow up was arranged at 6 and 24 months of operation. During the study period 51 patients were operated for fracture penis. Mean age at presentation was 32 years. The commonest cause of fracture penis was manual fiddling with the organ to overcome an erection [39.2%]. The incidence of associated urethral injury was 1.96% [n=1/51]. The commonest mode of presentation was with a cracking sound, local pain and immediate detumescence [90%, 98% and 94% respectively]. Average hospital stay was 3.4 days. Immediate postoperative complication was urinary retention in 2 patients [3.92%]. Long-term complications were negligible. There was only one readmission at 6 months for urethral stricture that responded well to optical urethrotomy. The commonest cause of fracture penis is manual manipulation to overcome an erection. The best treatment option is immediate surgical repair

comparative study of various types of hemorrhoidectomy

To compare the outcome of various operative procedures of hemorrhoidectomy. This comparative study was conducted in Surgical Department, LRH, Peshawar, from March to December 2005. Ninety patients with 2nd and 3rd degree internal hemorrhoids, were randomly divided in to three groups of 30 patients each: "Group A" low ligation and excision with anal stretch. [Group B]: low ligation and excision without anal stretch. [Group C]: closed hemorrhoidectomy. Postoperative pain was present in 4 [13.33%] cases in [Group A] and 3 [10%] cases each in [Group B] and [Group C]. Postoperative bleeding per rectum was present in 2 [6.66%] cases each in Group A and Group B and 1 [3.33%] case in Group C. Postoperative urinary retention was observed in 1 [3.33%] case each in Group A and group B only. Postoperative wound infection and Postoperative peri-anal abscess were recorded in 3 [10%] and 1 [3.33%] patients respectively in Group C only. Postoperative incontinence of flatus was reported in 1 patient [3.33%] of Group A only. Postoperative skin tags were seen in 2 [6.66%] cases of Group A, 1 [3.33%] case in Group B, and none in Group C. Recurrence was not observed in patients during follow up. Mortality was not encountered in the three groups. No statistical significance was found in these three operative procedures with respect to less pain during the early postoperative period and faster wound healing with no recurrence in any group

Ingestion of metallic rods and needles

Foreign bodies in gastrointestinal tract [GIT] are not very rare. This case describes a patient purposefully swallowing metallic objects. These were five iron rods ranging 4-5 inches in length, and two needles. One of the rod perforated duodenum and was found in pelvic cavity upon exploration. The rest of the rods were in small gut and stomach

Early outcome of transvesical prostatectomy for large prostatic adenoma

To determine the immediate postoperative course and complications following transvesical prostatectomy for large prostatic adenoma. Description study. This study was carried out in surgical A ward lady reading Hospital Peshawar, from 1[st] February 2004 to 31[st] July 2005. All patients who presented with bladder outflow obstruction and fulfilled the instruction and exclusion criteria were included in the study. After taking an informed consent history, clinically examination and related investigations were carried out. All these patients underwent prostatectomy by transvesical approach followed up for six months. The total number of patients was 173. The mean age of patients was 63.42 years and most of the patients [n 104-60 percent] presenting with benign prostatic enlargement were in the age range of 56-60 years. The common presenting complaints were prostatectomy by transvesical approach. The postoperative complications were recorded in 23 [13.29 percent] patients. Some patients had more than one complication. These were urinary tract incontinence in 3 [1.73 percent], urethral stricture in 3 [1.73 percent] and wound infection in 2 [1.16 percent] patients. One [0.58 percent] patient died due to myocardial infarction. Transvesical prostatectomy having a low incidence of complications, requiring no special equipment, is a good procedure for large prostatic adenomas

Frequency of carcinoma in specimens of clinically benign enlarged prostate

To determine the frequency of carcinoma prostate on histology.in specimens obtained from patients with clinically benign enlarged prostate. Descriptive study. This study was carried out in Khyber Teaching Hospital [KTH]Surgical ward D and Lady Reading Hospital [LRH] surgical ward A. Peshawar from January 2004 to December2004. A total of 107 patients who presented to Surgical OPD with bladder outflow obstruction and fulfilled the inclusion and exclusion criteria of the study were included in the study. After an informed consent history.clinically examination and related investigations were carried out. All the patients underwent transvesical prostatectomy [TVP] and their prostate specimens were subjected to histopathology. Total number of patients was 107. Most of the patients [58.88%] with benign prostatic hypertrophy [BPH] were in age range of 56 - 60 years. The common presenting complaints were prostatism [57.94%] and acute retention [34.58%]. All patients underwent trans vesical prostatectomy [TVP]. On histopathology 3.74% turned out as adenocarinoma prostate while 96.26% biopsies showed BPH. The mean age of presentation with carcinoma [Ca] prostate was 65 years.In this study the frequency of Ca prostate in specimens of clinically benign enlarged gland was 3.74%. Therefore all specimens must be submitted for histopathology after prostatectomy

Sentinel lymph node biopsy in the management of axillary involvement in breast cancer

To know the efficacy of sentinel lymph node biopsy in the management of axillary involvement in breast cancer. Material and This study was conducted in Surgical "A" unit of Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. A total of 30 patients with operable breast cancer diagnosed on fine needle aspiration cytology [FNAC] and clinically non-palpable lymph nodes in the axilla were studied. While on the operation table for modified radical mastectomy, one ml of sterilized solution of methylene blue was injected subdermally under the areola of the diseased breast. After 5-10 minutes sentinel lymph nodes were harvested via a small incision over the axilla, marked as blue nodes or blue lymphatics leading to a node. All the patients were females with mean age 45 +/- 13.48 years. Mean tumor size was 3.7 +/- 1.60 cm. The tumor was present in upper and outer quadrant in most [63.33%] of the patients. No complications were noted related to the procedure. The sensitivity of the method was found to be 85.7% and false negative rate was 7.1%. Sentinel lymph node biopsy with methylene blue is safe and cheaper and accurately predicts the axillary lymph node status in most of the patients