Single incision Trans scrotal versus standard inguino-scrotal orchidopexy in children with palpable undescended testis: our experience from April 2007 to April 2010

To compare the efficacy and complications of single incision trans scrotal versus standard inguinal orchidopexy in children with palpable undescended testes. This randomized controlled trial was conducted at the Paediatric Surgery Department Bahawal Victoria Hospital Bahawalpur from April 2007 to April 2010. Children aged 9 months to 12 years, diagnosed as cases of palpable undescended testes were randomized into two groups. In group A orchidopexy was performed through single scrotal incision and in group B by standard two incision inguinal approach. The groups were compared for operative time, hospital stay, scrotal hematoma, wound infection, and secondary ascent. Each group had 134 cases. Mean operative time and hospital stay in group A and B were 28.32 +/- 0.92 minutes and 47.83 +/- 0.76 minutes [p value 0.0001] and 1.027 +/- 0.205 days and 3.023 +/- 0.203 days [p value 0.0001] respectively. There was no significant difference in the formation of scrotal haematoma, wound infection and secondary ascent of testis between the two groups. The conversion rate of surgery in group A was 7.46%.Trans scrotal orchidopexy is the simple, effective and less invasive technique as compared to the standard two incision inguinal approach.

Omental caking: a rare manifestation of malignant peripheral nerve sheath tumour

Malignant peripheral nerve sheath tumour [MPNST] is a very rare tumour with an incidence of one per 100,000 and constitutes between 3 to 10% of all soft tissue sarcomas. Most of the sarcoma involve the extremities and retroperitoneal regions. However, this case presented with mass in left inguinal region and then spread rapidly to omentum, assuming the appearance of an omental cake. Mass responded well to chemotherapy comprising of Ifosfamide and Doxorubicin

Nephrotoxicity of CDDP assessed estimating glomerular filtration rate with 99mTc-DTPA plasma sample method

To assess early nephrotoxicity of CDDP [Cis-diamminedichloroplatinum] manifested by a decline in the glomerular filtration rate [GFR] estimated by plasma two sample clearance method [PSC 2] after 99mTc.DTPA injection. Descriptive study. Department of Nuclear Medicine, Karachi Institute of Radiotherapy and Nuclear Medicine, Karachi, from September 2004 to January 2005. The renal function was assessed on 36 patients suffering from different types of cancer and receiving CDDP in doses of >/= 50 mg/m[2] before and after in each of six CDDP cycles. The GFR was determined by PSC 2 method after 99mTc-DTPA injection]. A paired sample t-test was used for comparison of the mean value with significance at p < 0.01. There were [28 males and 8 females; age range being 16-68 years]. The average decline in GFR baseline to the end of sixth cycles was 43.86 ml/min/1.73m[2] [p=0.000] as estimated by PSC 2 method. There was a significant fall of average 9.36 ml/min/1.73m[2] [p <0.01] in GFR as observed in each cycle of CDDP estimated by the PSC 2 method. In the initial four cycles, CDDP produced a major nephrotoxic effect of average 10.27 ml/min/1.73m[2] [p <0.01] fall in GFR. This then gradually declined to a plateau of an average decline in GFR of 7.76 and 7.31 ml/min/1.73m[2] [p=0.000] after the 5[th] and 6[th] cycle respectively. CDDP produced an early nephrotoxicity which was manifested by a significant decline in GFR in each cycle. Tc-99m PSC 2 method for GFR estimation should be used periodically for the early detection of nephrotoxicity induced by CDDP

Diagnostic accuracy of Tc-99m-MIBI for breast carcinoma in correlation with mammography and sonography

To evaluate the accuracy of 99mTc-MIBI scintimammography [SMM] in differentiating malignant breast cancer from benign breast mass and in detecting axillary lymph node metastasis in comparison with mammography and ultrasonography. Comparative cross-sectional study. At the Karachi Institute of Radiotherapy and Nuclear Medicine [KIRAN], Karachi, from December 2006 to May 2007. A total of 28 patients [both with breast lumps or/and axillary masses] included were in the study. They underwent clinical examination, mammography and ultrasound imaging followed by planar SMM using a single head detector. All subjects received a 740-1110 MBq bolus injection of [99m]Tc-Sestamibi. 5-10 minutes and 1 hour delayed images were acquired after the injection. SMM scans were considered positive when there was focal area of increased radiotracer uptake. Qualitative [visual] as well as quantitative evaluation of scans was done and compared with ultrasound and mammography, taking histopathology as Gold standard. Sensitivity, specificity, negative and positive predictive values [NPV and PPV respectively] were determined. There were 22 patients presenting with breast lesions [20 palpable, 2 non-palpable] and 6 patients with axillary lump. Scintimammography accurately predicted malignant lesions in the breast [sensitivity 93.3%, specificity. 71.4%, PPV 87.5%, NPV 83.3%, overall accuracy 86.4%] as well as in patients with axillary metastasis [sensitivity 100%, specificity 66%, PPV 75%, NPV 100%, accuracy 83%]. A combination of scintimammography with any other imaging modality provides better results than a single test to detect breast cancer. SMM has good diagnostic accuracy in the detection of breast cancer as well as in axillary metastasis in association with mammography and ultrasound

Parotid swelling in children; our experience at department of paediatric surgery B.V.

To describe the clinical and pathological presentation as well as treatment options of parotid swelling in children. Descriptive case series study. Department of Paediatric Surgery Bahawal Victoria Hospital Bahawalpur. From Nov 2005 to Jul 2007. All patients of either sex below the age of 13 years presenting with parotid swelling were included in the study. Clinical presentations, preoperative investigations, operative procedures, histopathology reports, postoperative complications and further management [radiotherapy and chemotherapy] were recorded. Twelve patients presented with parotid swelling. Commonest presentation was a lump over the parotid region [100%] and pain [25%]. Majority of tumours were benign [50%]. Vascular lesions outnumbered solid tumours. 4 patients [33.33%] had haemangioma 1 patient [8.33%] had cystic hygroma, one patient each of pleomorphic adenoma, mucoepidermoid carcinoma and Adenocarcinoma. Salivary gland lesions are most likely inflammatory in origin. Vascular tumours are common benign tumours than epithelial tumours in children. Superficial parotidectomy is the operation for benign tumours and total conservative parotidectomy for malignant tumours

Estimation of glomerular filtration rate by using tc-99m DTPA plasma I sample method, Gates method, Cockcroft-Gault method and predicted creatinine clearance method: a prospective comparative analysis with plasma 2 - sample clearance method

To compare diagnostic accuracy of predicted clearance method, Gates method. Cockcroft-Gault method and plasma 1-sample clearance method with plasma 2-samples clearance method with Tc-99m DTPA for the estimation of glomerular filtration rate[GFR]. This study included 91 consecutive patients who were referred for evaluation of renal function to the Nuclear Medicine section of Karachi Institute of Radiotherapy and Nuclear Medicine [KIRAN] from September 2004 to September 2005. The GFR was determined simultaneously by 5 methods including Plasma two-Sample Clearance method after Tc-99m DTPA injection [PSC 2]; Plasma one-Sample Clearance method after Tc-99 m DTPA injection [PSC I]; Gamma camera uptake method after Tc-99m DTPA injection [Gates method]; Predicted Creatinine Clearance by Modification of Diet and Renal Diseases [MDRD]: and Cockeroft-Gault's equation for GFR estimation [CG]. PSC 2 was chosen as a reference, Out of the 91 patients, 71 were males and 20 females with age ranging from 16-68 years. The regression equation of the PSC 1, Gates, MDRD and CC method against the NC 2 was Y = 1.884+0.970X [r=0.90, p<0.001, SEE value-10, 23 ml/min/1.73m2]. Y = - 9.944 + l.083X [r=0.82, p<0.001, SEE valuel=11.02 mI/min/1.73m2], Y=25.606+0.640X [r=0.71, <0.002, SEEvaIuc=15.56 ml/min/1.73m2], and Y=14.9811-0.714X [r=0.77, p=0.002, SEE value=14.44 mI/min/1.73m2] respectively. In comparison with the GFR by PSC 2, the PSC I and Gates tended to overestimate by 1% [p=0.359] and 2% [p=0.265] respectively, MDRD and CC tended to underestimate GER by 11% and 14% respectively [p<0.001] PSC I correlate well with PSC 2 and either can be substituted for the other as ideal GFR markers. The Gates method shows good correlation with PSC 2 however it is less precise than PSC I. MDRD and CG methods due to significant underestimation are not considered as ideal GFR marker

Hypospadias repair

The Departments of Urology, Pediatric Surgery and Plastic Surgery, Quaid-e-Azam Medical College, Bahawal Victoria Hospital, Bahawalpur. Jan 1999 to Dec 2004. Prospective. Patients admitted with hypospadias in these departments were included in this study except patients with multiple failed repairs previously. Standard procedures were practiced for every type of defect i.e. MAGPI and Mathieu's repair for coronal hypospadias, Snodgrass urethroplasty for proximal and distal penile hypospadias. The age range observed during this study was 1.5 to 25 years while 64% of patients were less than 10 years of age. The type of defect was coronal in 25%, penile in 60%, penoscrotal and perineal in 15% of the patients. Initial success rate was 78% and overall success rate was 92%. Complications observed were fistula formation 7%, stenosis of anastomotic site 7% and dehiscence of repair 3%. Thorough evaluation of urethral and penile malformation brings best outcome of surgery for hypospadias. Hypospadias repair should be offered to the child before school going age so as to prevent psychological impacts of genital malformations

Omphalocele: various treatment modalities and their outcome: a study of 53 cases at the department of paediatric surgery B .V. hospital, Bahawalpur

To evaluate the out come of the different treatment modalities for omphalocele. Descriptive. At the department of paediatric surgery Bahawal Victoria hospital Bahawalpur from January 2004 to August 2007. Fifty three patients have been studied, 33 patients with a major defect, 20 patients with a minor defect and male to female ratio of 1:3. All the patients with minor defect were managed with primary closure while same was done in only 4 [12.12%] patients with major defect. Rest of the patients with major defect, 11 [33.33%], were managed conservatively followed by delayed primary closure, silo formation was done in 6 [18.18%] patients and ventral hernia was formed in 5 [15.15%] patients. 100% survival rate was found in patients who were managed conservatively with delayed primary closure. Overall mortality was found in 12 [22.6%] patients. Primary closure is the treatment of choice in exomphalos minor. Delayed primary closure after application of escharating agent is the Management of choice in patients with exomphalos major. Silo formation is considered in exomphalos major with ruptured membrane

Pyelopalsty; Comparison of results of repair with and without stents

To evaluate the outcome of pyeloplasty for congenital pelviureteric junction obstruction and comparison of results between repair with stents and without stents. Patients admitted to the department of Urology with congenital pelviureteric junction obstruction regardless of age were entered in this study. Prospective. Department of Urology, Quaid-l-Azam Medical College/ Bahawal Victoria Hospital, Bahawalpur. From April 1999 to December 2002. A total of 30 patients were grouped into A and B. Either dismembered or non-dismembered pyeloplasty were performed in either group, both with and without D.J. Stents. The results in our study show that there is no gross difference of outcome in pyeloplasty whether done over D.J. Stent or without stents. Dismembered pyeloplasty resulted in better outcome. Open pyeloplasty is the "Gold Standard" treatment option for congenital pelviureteric junction obstruction. The use of D.J. Stents is not necessary in every repair