Experience with spinal instrumentation for tuberculosis spine at PMCH Nawabshah

Spinal column is the common site of skeletal tuberculosis. Anteriorly there are three varieties: Paradiscal, Centrosomatic and Anterior Longitudinal. Extra-osseous involvement causes paravertebral abscess, epidural abscess or involvement of ligaments. The purpose of this study is to identify the frequency, presenting features, diagnostic tests and outcome of decompression and stabilization of tuberculous spondylitis. This study was conducted in Peoples Medical College, Nawabshah. All cases of spinal tuberculosis treated surgically were included. Admission criteria for these patients were advanced form of spinal tuberculosis, presenting with progressive deformity, neurological deficit, intractable pain, large paraspinal abscess or posterior element involvement. Over a period of 5 years, we had operated upon 248 cases of tuberculous spondylitis. Females dominated [1.91 times]. Bulk of series belonged to younger age group less than 40 years. Majorities of them had pain, neurological deficit and gibbus deformity. Surgery was performed to decompress the cord, apply a bony strut graft and stabilize with instrumentation. Thoracic region was commonly involved. Anterior approach was preferred because most of times anterior elements were involved. Webb Morley instrumentation system was used in majority of cases from D4 to L4. At the end of 6 months postoperatively pain relief was observed in 94.9% and neurological [motor] improvement in 92.2% cases. In this series we have observed that in our part of the world tuberculosis of spine is commonly seen in females and younger age group. Anterior decompression and stabilization is helpful in segmental rigid fixation of spine, pain relief deformity correction and early neurological recovery

study of vesicovaginal fistulae repair at gynaecological surgical camp at peoples medical college hospital Nawabshah

To evaluate the predisposing factors for vesicovaginal fistulae [VVF], route of fistula repair and outcome of surgery. Total 21 patients of VVF were admitted. 15 - 24 October 2002 Department of Obstetrics of Obstetrics and Gynaecology at PMCH Nawabshah, Sindh Out of 2I VVF, 14 of them were due to obstetrical trauma, 5 occurred due to gynaecological surgery and 2 were congenital. 18 cases were repaired vaginally and 2 were repaired with abdominal approach. One case was not repaired due to impacted bladder stone. Success repair was in 18 cases and 2 were failed. The success rate was 90%. The key for success was adequate tissue mobilization, division of scar tissue and good postoperative care

Sacrococcygeal teratoma in infants and children review of 17 cases

Sacrococcygeal teratoma a congenital tumor, may present at birth or at later in childhood. Altman's type 1 and 2 are most commonly seen while type 3 and 4 are rare. Sacrococcygeal teratoma may be benign with mature tissue and malignant with immature elements. Apart from surgery, adjuvant chemotherapy and radiotherapy may be needed in few cases. This Study conducted retrospectively to examine spectrum of 17 cases of sacrococcygeal teratoma received in infancy and childhood in the dept: of pediatric surgery People's Medical College Nawabshah from 2001 to 2005. Female predominance found. Most of patients underwent through classical inverted chevron incision except two, which require abdomino-sacral approach. Benign histology found in 15 cases and two had malignant pathology, which required chemotherapy. In 2 years follow-up no recurrence found. From our study we found most of lesions were benign. Combined approach usually required in Altman's type 3, and early presentation always revealed benign pathology