Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores-A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Abstract Introduction Posttonsillectomy pain results in significant morbidity to the patients. There is a disagreement in the literature regarding the use of local anesthetics during tonsillectomy. The aim of this placebo-controlled, double-blind study is to evaluate the effect of peritonsillar administration of local anesthetics. Objective To evaluate the role of intraoperative use of analgesics in tonsillar fossa and postoperative evaluation with visual analogue scale (VAS) scores in achieving pain relief after tonsillectomy procedure Methods In this study, 180 patients were randomized to 1 of the 6 groups: bupivacaine infiltration, lidocaine infiltration, normal saline infiltration, bupivacaine packing, lidocaine packing, and normal saline packing. Pain caused by speaking, swallowing, and on rest was assessed using VAS at 4, 8, 12, 16 hours, and at discharge. Results Significant analgesia was obtained in patients who received bupivacaine infiltration and packing compared with placebo (p < 0.05). The majority of the study subjects had no postoperative complications, and patients receiving bupivacaine infiltration required less additional analgesics in the first 24 hours after surgery. Conclusion We advocate the use of bupivacaine infiltration or packing immediately following the procedure to achieve adequate postoperative analgesia.

Career choices of medical doctors at graduate level - a multicenter study

Objective: To find out the specialty choices being taken by Final year Medical students and graduate Doctors

Method: This is a cross sectional survey study which was conducted over two months from 1[st] November to 31st December 2016. Final year students and house job doctors were asked for the filling of Performa, after filling the consent form. A self -developed, anonymous questionnaire was used to conduct the study using close ended type of questions. This was a multi-center study conducted at Dow International Medical College and Jinnah Medical and Dental College. An IRB approval was taken for the study. A total of 317 individuals completed the Performa. Demaographic data included information regarding the year of passing, number of family members already in the medical profession, then specific questions were asked regarding their future career choice and the reason for choosing that particular speciality. After collection of data from both the centers a single operator entered the Data on SPSS 16 version. Frequencies and chi-square test were performed and p-valves were tabulated

Results: A total of 317 individuals completed the Performa. Two hundred and nine participants [65.9%] were females and one hundred and eight [34.1%] were male participants. The age ranged from 22-29 years mean of 25.15 and SD of 1 .348. One hundred and twenty one [38%] had a family member as a doctor in the family. Medicine and allied was the most sought after specialty 184[58%], followed by surgery and allied in 108[34%]. Non-Clinical Specialty such as radiology, basic sciences was taken up by 27[7.9%]

Conclusion: The working hours followed by passion for the chosen field were the important reasons for selecting any specialty. The next most important reason was higher income and other family responsibilities of an individual. The ladies are opting more for fields with a controllable life style

Audiolgical results of type I tympanoplasty by underlay technique with temporalis fascia graft

To determine subjective hearing improvement experienced after closing perforation of various sizes with temporalis fascia grafts by underlay type I tympanoplasty. Prospective study. This study was conducted at the department of Ear, Nose, Throat, Head and Neck Surgery, Jinnah Postgraduate Medical Center Karachi from 01.04.2004 to 31.10.2006. 100 consecutive cases of either sex, age ranging from 18 to 40 years [mean age 31.2] of tubo-tympanic type of chronic suppurative otitis media, with dry central tympanic membrane perforation for last six weeks, having good cochlear reserve and air bone gap between 30dB to 40dB, admitted for tympanoplasty were included for this study. Patients with active ear discharge, frequently or recently discharging ear [history of ear discharge of less than 6 weeks] were excluded. Patients associated with upper respiratory tract pathologies including deviated nasal septum, sinusitis, chronic tonsillitis or pharyngitis and patients with only hearing ear were also omitted from the study. Out of the 100 patients tested, the mean air conduction threshold was 40dB preoperatively and 28dB post-operatively, while the mean bone conduction threshold remained the same pre and post-operatively i.e. 15dB. On post-operative audiometric analysis 51 ears had a post -operative air-bone gap of 10dB or less, air bone gap closed completely in 4 patients, reduced upto 15dB in 26 patients, while in the remaining 19 ears there was no improvement noted. Type-I tympanoplasty underlay technique using the temporalis fascia graft has good functional results in young patients with dry central perforation. For good hearing results, selection of cases has prime importance

Neck recurrence in early carcinoma tongue

To study the efficacy of different locoregional treatment options for tongue cancer in determining the prognosis, with reference to recurrence of disease in neck. This is a retrospective analysis of 80 patients with early [T1/T2] carcinoma tongue who had hemiglossectomy with or without neck surgery and radiotherapy for 14 years. Eighty patients were included in this study, 49 [61.3%] men and 31 [38.8%] women; 36 [45%] patients with T1 lesion and 44 [55%] with T2 lesion. Sixty two patients [77.5%] were staged cN0 and 18 patients had a clinically palpable neck nodes [cN+]. Thirty seven patients were pathologically negative [pN0], whereas 22 were pathologically positive [pN+] and 21 were not operated so they were staged pathologically [pNx] [undissected necks]. Thirty patients received postoperative adjuvant radiotherapy. The median follow-up was 16.5 months with a range of 10-120 months. The over-all rate of recurrence in neck was 32.5% [27 patients]. The rate of recurrence was 23% in T1 and 45.8% in T2 lesion [P-value 0.09] without radiotherapy. The recurrence rates with T1 lesion patients who were given adjuvant radiotherapy did not change significantly whereas with T2 lesions the recurrence rate decreased from 45% to 25% in the group without radiotherapy. Recurrence rate was higher in undissected neck as compared to patients who underwent elective neck dissection having radiotherapy and staged pN0 [P-value 0.009] or pN+ [P-value 0.005]. Patients having therapeutic neck dissection, on comparison of final pathological node staging [i.e. pN0 or pN+] the rate of recurrence in patients pN+ was 56% and in group with pN0 it was 11%, with [P-value 0.046]. We did not find any effect of age, gender and surgically resected margins of primary early tongue tumor on recurrence of disease in neck. There was no significant difference between primary tumor stage T1 and T2 lesions on neck recurrence when treated with surgery alone, but adjuvant radiotherapy further reduced the neck recurrence in T2 groups. Adjuvant radiotherapy also showed a significant reduction in recurrence rates in both pN0 and pN+. Undissected necks have higher incidence of neck recurrence than dissected neck irrespective of pathological status of neck metastasis