ABSTRACT
Paired kidneys are located retroperitoneally in para-vertebral gutters and receive 20% of cardiac output. Each kidney is supplied by a single renal artery from aorta in 70% of individuals. Identifying and reporting variations in renal vasculature. This was a case report, from CMH Lahore Medical College, Lahore. Anatomical variations in the vascular pattern of kidneys have been well documented in medical literature. Aberrant renal arteries hold significant importance in diagnostic and therapeutic strategies. Knowing the possibilities of aberrant renal vessels, provides a better approach to radiological and surgical interventions in cases of nephrectomies, renal tumors, transplants and renal vascular disorders. In this milieu, present case is being reported to highlight multiple variations in renal vascular pattern. There was left sided accessory renal artery originating from aorta along with unusually long and little tortuous principal renal artery. There was hilar congestion due to complex arrangement of unusually long pre-hilar portion of segmental veins draining into short renal vein. On the right side extra-hilar [aberrant] renal arteries combined with complex branching pattern of renal arteries was observed in a 40 years old male cadaver, detected during dissection performed in routine gross anatomy course
ABSTRACT
To compare the short term outcome of stapled haemorrhoidectomy with excisional haemorrhoidectomy. Prospective comparative study from June 2005 to April 2006. Setting: Department of Surgery [Unit IV], Bahawal Victoria Hospital, Bahawalpur. The study included 37 patients of 3rd to 4th degree prolapsed haemorrhoids. The data of all the patients was collected. Seventeen out of them underwent stapled haemorrhoidec-tomy [Group-I] while 20 underwent excisional haemorrhoidectomy [Group-II]. Short term outcome of both groups were compared. The comparison criteria was operative time, hospital stay, post-operative pain, post-operative bleeding requiring intervention, patient?s satisfaction and total cost in rupees. Both the groups were comparable as far as age and gender distribution, and the stage of the disease was concerned. The operative time in Group-I was 35 minutes and in Group-II 65 minutes [p<0.001]. Mean hospital stay was lower in Group-I as compared to Group-II [1.09 vs 2.82 nights, p<0.001]. Objective assessment of pain showed less post-operative pain in patients with stapled haemorrhoidectomy [p 0.04]. No patient of Group-I, but 15% of Group-II bled post-operatively. Ninety one percent patients with stapled haemorrhoidectomy were satisfied with the procedure whereas only 70% showed their satisfaction in Group-II. The cost of stapled haemorroidectomy was six times more than excisional haemorrhoidectomy. Stapling haemorrhoidectomy is a safe procedure for prolapsed haemorrhoids. It has definite short term advantages over excisional haemorrhoidectomy with reference to post-operative pain and early recovery. Patients` acceptance and satisfaction are high. However, it is more costly and this factor is important in our circumstances