Effectiveness of Limberg flap in recurrent chronic pilonidal sinus disease

To describe outcome of Limberg flap in chronic recurrent pilonidal sinus disease. Case series. This study was done at Surgical Unit-3, Liaquat University Hospital, Hyderabad [LUMHS] from February 2005 to March 2012.Through sampling of convenience all patients irrespective of age and gender with chronic recurrent pionidal sinus disease were included. During the study period 25 patients were enrolled. Two patients were lost to follow-up and were excluded from final analysis. All 23 patients were males, with mean age of 27 year. The mean operative time was 52 minutes and mean hospital stay of 7 days. None of the patients developed flap failure. No recurrence was noted for a mean follow up period of 10 months [range 9-12 months] The Limberg flap for recurrent chronic pilonidal sinus disease was safe and easy to perform procedure with minimum morbidity and early recovery

Efficacy and side effects of glyceryl trinitrate in management of chronic anal fissure

Various options are available for treatment of chronic anal fissure, each with its own associated complications. This study aimed to evaluate the efficacy of topical Glyceryl Trinitrate [GTN] for anal fissures in an outpatient setting. A prospective experimental study was carried out at the outpatient department of Surgical Unit IV, Liaquat University Hospital from Aug 2004 to Jul 2005. Total 100 patients fulfilling the criteria of chronic anal fissure were included in the study. Patients presenting with chronic anal fissure but with associated comorbidities were excluded. Data were collected on a designed questionnaire, and analysed using SPSS-10. Sixty women and 46 men were included in the study with a mean age of 30 years. After the end of 8 weeks of treatment, 76 showed healing of fissure and relief in symptoms whereas 20 patients either had improvement in symptoms or did not heal. The commonest side-effect was headache reported by 21 patients. The minimum period of follow-up was one year, and 7 patients had recurrence. Topical 0.2% GTN is an effective first-line agent in managing chronic anal fissure. The associated side effects and recurrence remains a matter of concern.

Conservative lateral internal anal sphincterotomy versus topical diltiazem in the management of chronic anal fissure

To compare and assess the efficacy of conservative lateral internal sphincterotomy with topical diltiazem in the management of chronic anal fissure. Quasi experimental. Surgical Unit IV, Liaquat University of medical and health sciences, Jamshoro from 1st March 07 to 31st August 08. In total, 70 patients were included in the study and were divided into two groups. Group A was prescribed topical diltiazem whereas group B underwent conservative lateral anal sphincterotomy. Patients were followed up at 2nd, 4th and 8th week. The markers of efficacy were pain relief, healing of fissure, incontinence and recurrence. Data was collected on a questionnaire and was analyzed statistically using SPSS version 10. The p values were calculated using chi-square test and were considered significant below 0.05. Conservative lateral internal anal sphincterotomy produced a statistically significant response in comparison with topical diltiazem in terms of pain relief at first follow up [p=<0.001]. It was also associated with a better response rate of healing of fissure at the end of study and recurrence rates [p=0.002, 0.019]. However, at the end, topical diltiazem was associated with symptomatic relief in study population that was statistically insignificant [p=0.033]. Also patients who underwent conservative lateral internal sphincterotomy, 3 of them developed transient incontinence. None of the patients in diltiazem group experienced fecal incontinence. Conservative lateral internal anal sphincterotomy remains the modality of choice in the management of chronic anal fissure as it provides early pain relief, better healing rates and minimum number of recurrence. However, topical diltiazem can be prescribed as first line of management since it is non-invasive and is free of complications associated with surgical division of internal anal sphincter

thyroidectomy safe after identification of recurrent laryngeal nerve - fact or fiction

Injury to recurrent laryngeal nerve remains a common complication of thyroid surgery. It is argued whether routine dissection leads to increase risk of palsy or otherwise. To assess recurrent laryngeal nerve injury risk during thyroidectomy with and without routine identification of the recurrent laryngeal nerve during surgery. Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad over 3 years. The frequency of recurrent laryngeal nerve injury following surgery for benign, nontoxic thyroid disease was studied in consecutive patients undergoing hemithyroidectomy, subtotal thyroidectomy or near total thyroidectomy. Patients with benign and non toxic goitre were included in the study while those with toxic goitre and malignancy were excluded. A total of 88 patients were included in the study. They were divided into two groups, group A included patients in whom dissection of recurrent laryngeal nerve was done as standard procedure while in group B, the nerve was not exposed. There were 34 unilateral and 54 bilateral explorations. The mean age of patients in the two groups was almost same, with preponderance of females [M:F ratio 1:17]. The incidence of recurrent laryngeal nerve injury was not significant in both groups [p=0.502], but the incidence of nerve injury in patients who underwent near total thyroidectomy was 17.6% compared to 0.17% in patients who had hemithyroidectomy, indicating that it is not the exploration but the extent of thyroid resection that is a risk factor for recurrent laryngeal nerve injury. Dissection of nerve does not significantly reduce the risk of recurrent laryngeal nerve injury therefore, routine exploration of the nerve during thyroid surgery is not recommended in an expert hand

Diltiazem [2%] versus glyceryl trinitrate cream [0.2%] in the management of chronic anal fissure

To assess and compare the effectiveness of topical 0.2% glycerl trinitrate [GTN] and topical 2% diltiazem [DTZ], in the management of chronic anal fissure. Comparative, descriptive study. Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad from September 2004 to August 2005. Patients with chronic anal fissure were treated with topical 0.2% GTN [50 patients] and 2% DTZ [47 patients] application for 8 weeks, three times a day at peri anal area. Symtoms, recurrence, wound healing and side effects were compared. Data was analyzed using SPSS version 10 employing X[2] test. A p-value below 0.05 were considered statistically significant. There were 53 females and 44 males with a mean age of 30 years. Patients who received topical diltiazem [DTZ] showed statistically significant difference than those who were prescribed topical glycerl trinitrate terms of wound healing and side effects mainly the headaches [p=0.02 and 0.003 respectively]. Improvement in symptoms [p=0.345] and recurrence rates [p=0.612] turned to be statistically insignificant although recurrence rate was lower with DTZ. Chemical sphincterotomy is an effective first line management for chronic anal fissure. Both GTN and DTZ are equally effective in managing the chronic anal fissure. DTZ has fewer side effects, a better healing response and low recurrence rates

Stress levels in medical residents of a teaching university in the province of Sindh, Pakistan: its effects on the quality of life of residents

Stress and stress-related illnesses are common in medical residents. If remain unattended, these illnesses might have serious repercussions affecting the quality of patient health care and physician's well-being. In this study, we evaluated the stress levels of medical residents in a teaching university [Liaquat University of Medical and Health Sciences, LUMHS] and compared them with those observed in postgraduate students pursuing M. Phil or Ph. D. degrees in basic sciences [University of Sindh]. We used Perceived stress Scale of Cohen et al and wellbeing Scale of Kaplan et al for the measurement of stress. A total of 100 questionnaires [50 per group] were given out. The recovery rate was 73%. Our data on Perceived Stress Scale indicated that there was statistically significant differences between the two groups [p=0.006], indicating that the medical residents were facing higher levels of stress as compared to postgraduates in basic sciences. However, we failed to detect male to female differences in either group. Similarly, there were significant differences on well-being Scale between the two groups [p=0.002]. Our results confirmed the previous findings that medical residents experience higher levels of stress. However, we did not observe any significant differences between and female residents. When under stress, the respondents tend to neglect the normal activities of life, became reclusive and had self-doubts. The later may have some serious consequences on patient health care

Pattern of ovarian tumors: report of 15 years experience at Liaquat University Jamshoro

To evaluate the morphological pattern of different ovarian tumors among the rural population of Sindh. Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh - Pakistan over a period of fifteen years. A descriptive study. All specimens, received by the department were examined, however, only those specimens that belonged to interior of Sindh were included in the study. Data were recorded on a proforma and were analyzed statistically. In total, 694 ovarian tumor specimens were examined. Majority of these tumors was benign [68.28%]. Tumors of low malignant potential borderline] were <01%. Those with frank malignant features were 31%. On cytological basis, tumors taking origin from surface epithelium were most frequent, constituting 81% of the total. Germ cell tumors were second in the row with percentage of 10.95. Metastatic deposits were seen in only 1.58% of the cases. Ovarian tumors are quite common in this set up. A relatively high number of malignancies was observed in this study and the etiology of which is yet to be established

Sublingual dermoid cyst

A case of 22 years old male with a sub lingual swelling causing discomfort in deglutition and speech is reported. The pathology was diagnosed as sub lingual dermoid cyst. It was completely excised from an oral approach. Later, the normal functions of tongue were restored without any residual complaint