Rubber band ligation vs injection sclerotherapy in office management of 1st and 2nd degree hemorrhoids

To compare the effectiveness and complications of Rubber Band Ligation [RBL] with Injection Sclerotherapy [IST] in the treatment of 1st degree and 2nd degree hemorrhoids. Randomized Controlled Trial. CMH Rawalpindi, from 1st Feb to 30 Sep 2007. A total of 120 patients were selected for study. 60 patients with 1st degree haemorrhoids were placed in group I and 60 patients with 2nd degree haemorrhoids were placed in group II. These patients were then randomly divided into two sub-groups 'A' and 'B' through Random Allocation by Table of Random Numbers. Group 'IA' had 30 patients of 1st degree haemorrhoids and group 'IIA' had 30 patients of 2nd degree haemorrhoids. Similarly group 'IB' had 30 patients of 1st degree haemorrhoids and group 'IIB' had 30 patients of 2nd degree haemorrhoids. Then groups 'IA' and 'IIA' were subjected to RBL and Groups 'IB' and 'IIB' were subjected to IST. The outcome measures were relief of symptoms, recurrence rate and complications. Male to female ratio was 11:1. Among patients subjected to RBL, 58.3% were from age group 2 [31-50 yrs] with mean age 42.90 +/- 11.74 yrs and mean duration of symptoms was 6.24 + 4.91 months. Among patients subjected to IST, 55% were from age group 2 [31-50 yrs] with mean age 45.62 +/- 12.49 yrs and mean duration of symptoms was 7.03 + 4.76 months. Important immediate complication was pain, but majority of patient were pain free. In group IA 36.7% patients had slippage of ligature but none of the patients undergoing IST developed Prostatitis. Visible bleeding was the main complication in group 'IA' 4th week [p < 0.05]. Response to IST among 1st degree haemorrhoids was significant at 4th week i.e. 90%, as compared to RBL, i.e. 63.3% [p <0.05]. IST is treatment of choice for 1st degree haemorrhoids, but for 2nd degree haemorrhoids, both RBL and IST are equally effective

Frequency of duodenal ulcer perforation with radiological evidence of pneumoperitoneum

To determine the frequency of duodenal ulcer perforation with radiological evidence of gas under the diaphragm on X-ray chest. Descriptive. Department of Surgery Combined Military Hospital [CMH] and Military Hospital [MH], Rawalpindi, from Nov, 2005 to May 2006. Patients with acute abdomen presenting as emergency at CMH and MH Rawalpindi were evaluated. Preoperatively X-ray chest PA view, in standing posture, was done in all cases and presence or absence of pneumoperitoneum noted. The patients were then followed by laparotomy to confirm or otherwise a perforation of duodenum. Only 30 patients were included in the study where duodenal perforation was confirmed per-operatively. Pneumoperitoneum on X ray chest PA view was found in 25 [83.3%] out of 30 patients with duodenal ulcer perforation; The remaining 05 patients i.e. 16.67% did not show pneumoperitoneum. X-ray chest is a helpful tool in diagnosing majority of patients with a perforated duodenal ulcer. However there is a significant number of patients where the clinical acumen of the doctor would help in an early diagnosis and prompt treatment

Comparison between delayed-absorbable polydioxanone and non-absorbable [prolene] suture material in abdominal wound closure

The objective of this study was to compare Polydioxanone [PDS] and Prolene suture material for abdominal fascial closure regarding morbidity in terms of post-operative wound complications. Cohort comparative ramdomized study. Dept of surgery Combined Military Hospital Rawalpindi from January 2002 to December 2003. A series of 100 patients presenting in the General Surgical OPD and requiring midline laparotomy were studied. In group "A" all the midline abdominal wounds were closed with Prolene 1 and in group "B" PDS 1 was used. In both the groups the data was collected, based on post-operative wound complications including post-operative wound pain, wound infection, wound dehiscence, suture sinus formation, stitch granuloma and incisional hernia. All the post-operative wound complications were then compared between the two groups. Our results show that the post-operative wound infection, wound dehiscence, suture sinus formation, stitch granuloma and chronic wound pain were significantly lower with PDS 1 as compared to Prolene 1, without any significant increase in incisional hernia formation. Slowly absorbable suture material [PDS] appears to be superior than non-absorbable suture material [Prolene] in midline abdominal fascial closure

Comparison o frequency of postoperative wound infection with the use of scapel/diathermy during electiv cholecystectomy

To determine frequency of postoperative wound infection with the use of scalpel /diathermy during elective cholecystectomy. Cross sectional [comparative] study. Surgical department unit IV, Military Hospital Rawalpindi and PNS Shifa Karachi, from September 2004 to March 2005. All patients [female and male] presenting with symptomatic gall stones who underwent open cholecystectomy through standard right upper transverse incision were included in the study. Patients were divided into two groups. Group A included 30 patients who underwent open cholecystectomy with scalpel and group B included 30 patients who underwent open cholecystectomy with diathermy. All patients who were having any co-morbid conditions like, diabetes mellitus, immuno-compromised state, pre existing infection at the site of skin incision and previous surgery were excluded. It was observed that out of 60 patients only 3 patients developed post operative wound infection In group A out of 30 patients with scalpel cutting only 1 patient developed wound infection which is 3.3% while in group B out of 30 patients with diathermy cutting only two patients developed wound infection which is 6.6%. Various other observations were found that males who developed cholelithiasis were 8.33% and females were 91.66%. Age distribution was minimum 27 years, maximum 75 years and mean age was 48.8 years. This study concluded that ratio of wound infection with scalpel cutting is less as compared to diathermic cutting and we can protect the patient from wound infection with the use of scalpel

Monkey bite

Monkey bites have been reported less frequently in medical literature as compared to other animal bites. An animal keeper of a zoo was bitten by a monkey resulting in multiple would all over body more so on genital area. They were in form of lacerations and crushing with puncturing patterns. Wounds were irrigated and debridement done. Antibiotics cover with tetanus and rabies prophylaxis were given Secondary suturing was done later. The recovery was smooth without any residual defect

Repair of retrohepatic inferior vena cava injury

A 10 years old child was brought to the Emergency Department of Combined Military Hospital [CMH], Lahore with a history of trivial injury due to fall from a bicycle. He was found to be having severe intraperitoneal hemorrhage. Immediate resuscitation in the emergency department could not revive his vital parameters. He was operated upon in emergency and found to be having grade V hepatic injury extending into retrohepatic inferior vena cava. Child was operated under general anesthesia and recovered well postoperatively without any residual complication