Closed reduction and percutaneous fixation with crossed k-wires in displaced supracondylar fractures of humerus

To evaluate the out-come of closed reduction under image intensifier and percutaneous cross k-wire fixation in Gartland Type II and III supracondylar fractures of humerus in children. Case series . Combined Military Hospital Rawalpindi and Combined Military Hospital Malir, from Jun 2006 to Jan 2012. Patients 3-10 years of age, of both genders were included in the study by convenience sampling. Patients who had closed Gartland Type II and III fractures and reported within 24 hours of injury were included in the study. Standardized percutaneous cross. K wiring [medial and lateral] was performed in all the patients, followed by casting, by an orthoropedic surgeon. K wires were removed after four weeks. Patients were followed for upto 06 months and all the early and late post-operative complications were recorded on the given proforma. Evaluation of the results was done on the basis of Flynn's criteria by measuring loss of elbow motion and carrying angle. A total of 30 patients completed the study. The mean age was 6.1 years with a gender distribution of 23 males and 7 females. The involved elbow was right in 17[56.6%] patients and 13[43.3%] patients had left sided injury. There were 18[60%] Gartland type II fractures and 12[40%] Gartland III fractures. All of the fractures were extension type. Three patients [10%] had pin tract infections, whereas none had osteomyelitis, neurovascular damage or compartment syndrome. Twenty four patients [80%] had excellent results according to Flynn's criteria whereas four patients [13.3%] had poor results. Closed reduction under image intensifier and percutaneous K wiring through medial and lateral approach in selected Gartland Type II and III fractures in children is a safe procedure and provides adequate stabilization with satisfactory results

Aetiological factors in mechanical intestinal obstruction

Background: Intestinal obstruction occurs when the normal flow of intestinal contents is interrupted. The most frequent causes of intestinal obstruction are postoperative adhesions and hernias, which cause extrinsic compression of the intestine. Less frequently, tumours or strictures of the bowel can cause intrinsic blockage. Objective of the study was to find out the various aetiological factors of mechanical intestinal obstruction and to evaluate the morbidity and mortality in adult patients presenting to Surgical 'A' unit of Ayub teaching hospital with mechanical intestinal obstruction. Methods: This cross-sectional study was conducted from March 2009 to September, 2009. All patients presenting with intestinal obstruction and were above the age of 12 years were included in the study. Patients with non-mechanical obstruction were excluded from the study and those who responded to conservative measures were also excluded. Results: A total of 36 patients with age ranging from 12 to 80 years [Mean age 37.72 +/- 19.74 years] and male to female ratio of 1.77:1, were treated for mechanical intestinal obstruction. The most common cause for mechanical intestinal obstruction was adhesions [36.1%]. Intestinal tuberculosis was the second most common cause [19.4%], while hernias and sigmoid volvulus affected 13.9% patients each. Malignancies were found in 5.6% cases. Conclusion: Adhesions and Tuberculosis are the leading causes of mechanical intestinal obstruction in Pakistan. Although some patients can be treated conservatively, a substantial portion requires immediate surgical intervention. Keywords: Intestine, Mechanical [Dynamic], Intestinal obstruction

Otogenic intracranial complication

Two patients one male of 25 years the other a girl of 10 years old presented to us with purulent ear discharge, severe hcadache and nausea/vomiting and amastoid abscess in one of them of few days duration. Otoscopy revealed purulent foul smell discharge filling the ipsilateral ears with X-ray mastoid showing a cavity due to bone erosion. Incision and drainage of mastoid abscess followed by radical mastoidectomy in one and radical mastoidectomy straight away in the other were performed with complete eradication of disease and chlesteatoma was achieved clinically. But within 16 hour in the young girl and after 12 days in the 25 years old male again both cases presented in emergency with sever headache, nausea/vomiting and disorientation. CT scan of both the cases revealed right temporal lobe abscess. The girl was already in ICU and the male was re- admitted for the drainage of abscesses under care of neurosurgeon and follow up was done in both the departments for four months

Comparative study between dissection and diathermy tonsillectomy

Dissection and diathermy are commonly used techniques of Tonsillectomy with quite satisfactory results with either of the two, for which a number of studies have been made many a times all over the world. However, at our end, another analysis of the results of these techniques was done to find out a procedure which has least preoperative and postoperative morbidity. A study towards that end was conducted at the departments of Ear, Nose and throat and Head Neck Surgery, Jinnah post Graduate Centre [from June 1998 to June 2000] and continuation of the study at Baqai Medical University Hospital [from June 2000 to July 2006] Patients of ages between 13 years and 50 years were selected from the outpatient departments of both setups in a randomized fashion. Sample size was 200 patients. For uniformity sake, one tonsil was dissected followed by ligature homeostasis and the other tonsil of the same patients was removed by diathermy. It was found that the difference in results between the two techniques was statistically insignificant [P<0.001] in terms of intra operative blood loss and time taken for surgery. Regarding postoperative hemorrhage and post-operative pain, the difference between the two was statistically significant [P=0,234] in favour of dissection method. Hence it is concluded that tonsillectomy with diathermy was a better technique compared to dissection method in terms of intra operative blood loss and time taken for surgery. However it is associated with painful recovery and significantly higher risk of postoperative hemorrhage and therefore can have morbidity higher than the dissection method of tonsillectomy

Transitional cell carcinoma of the nasal cavity

A 40 years old female presented with left nasal obstruction, sneezing and watery discharge for the last three months. Clinically left proptosis and widening of the nasal bridge was obvious while the left nasal cavity was full of multiple greyish grapes like polypoid masses which were painless and did not bleed on manipulation. CT scan revealed soft tissue mass occupying the left nasal cavity, maxilla, infra temporal fossa, ethmoid, sphenoid and the orbit. The mass was excised in toto through left Lateral Rhinology approach and histology examination revealed it to be a transitional cell carcinoma