ABSTRACT
To compare the outcome of open Milligan-Morgan haemorrhoidectomy [MMH] with that of closed Ferguson haemorrhoidectomy [FH] regarding post operative pain, wound healing and complications. Quasi Experimental study design. The study was conducted from 1st of May 2008 to 31st December 2013 at Islamic International Medical college Hospital Islamabad. Forty eight patients suffering from haemorrhoids were divided into two equal groups by consecutive sampling method. In 24 patients [group I] haemorrhoidectomy was done by open method [Milligan-Morgan], and remaining 24 patients [group II] were treated by close method [Ferguson]. Outcome in the two groups such as post operative pain, wound healing, anal stenosis and anal incontinence were compared. Post operative pain was less in group-ll [close] compared to group-l [open]. In group-ll pain score on VAS was 4.8 at 8 hours post operatively which subsided to 2.1 at 48 hours, mean score was 2.9. In group-l post operative pain on VAS was 7.2 at 8 hours which came down to 3.8 at 48 hours, mean score was 5.28. Wound healing in group-ll [close] took 7 to 12 days, while in group-l [open] it occurred in 15 to 25 days. Post operatively analgesia was required for an average 10 days in group-ll, and for 19 days in group-l patients. Anal stenosis and anal incontinence were not noted in either group within 6 months. Close haemorrhoidectomy has shown better outcome compared with open haemorrhoidectomy in terms of post operative pain, analgesic requirement and wound healing. Anal stenosis and anal incontinence are not seen in either group within observation period of 6 months
ABSTRACT
To compare the complete healing of chronic anal fissure by using 2% nifedipine paste and 0.5% glyceryl trinitrate ointment each applied locally for 6 weeks. Randomized Controlled Trail. Surgical Unit-I, Pakistan Railway Hospital Rawalpindi spanning over a period of 06 months starting from March 2011 to August 2011. Seventy six patients of chronic anal fissure were included in the study. Non-probability convenience sampling was used for the enrolment of patients. Patients were divided equally into two treatment groups A and B. Group [A] was treated with topical 2% nifedipine paste and Group [B] was treated with 0.5% glyceryl trinirate ointment. Patients were asked to come for the follow up after six weeks to look for symptomatic improvement and healing rate. All 38 patients included in the study completed the follow up after 06 weeks of treatment in either group. Three patients from Group B experienced intractable headache and were managed by analgesics accordingly but they went on to complete the treatment. None of the patient in group A had any significant side effect causing any adjustment in the treatment. At the end of 06 weeks of treatment, 28 patients in Group A and 25 in Group B showed complete healing of anal fissure. The overall healing rate was 69.75% [n=76]. There was statistically no significant difference at the end of 06 weeks of treatment [p=0.454]. It is concluded that 2% nifedipine paste is as effective as 0.5% GTN ointment in terms of healing of chronic anal fissure
ABSTRACT
Objective: To observe whether duration of pain is a true reflector of operative findings in patients with acute gall bladder diseases
Study Design: Observational analytical
Place And Duration: Surgical Unit-ll, Pakistan Railway Hospital Rawalpindi spanning over a period of 02 years from May 2010 to may 2012
Methodology: 60 patients with acute gall bladder diseases were included through non probability convenience sampling. A proforma was designed to include clinical features, diagnostic work up, treatment plan and operative findings
Diagnostic work up included complete blood picture, liver function tests, hepatobiliary ultrasound. HIDAscan and CTscan was done if needed. Routine hematological and radiographic studies as indicated were performed
Results:: A total of 60 patients were studied and among them majority 83.3%[n=50] were females. In Patients with biliary colic group 41.7%[n=25], Murphy's sign was positive in 56%[n=14] and pathology on ultrasound scan was detected in 84%[n=21] of the patients. In patients with acute cholecystitis, fever 71.4%[n=25], Positive Murphy's sign 71.4%[n=25] and raised total leukocyte count 88.5%[n=31] were the commonest findings. Per operatively 68%[n=17] patients had chronically inflamed gall bladder and 16%[n=4] had acutely inflamed gall bladder among patients having symptoms of less than 12 hours duration. Acute inflammation of gall bladders commonly observed 65.7% [n=23], followed by chronically inflamed gall bladder 28.5%[n=10]
Conclusion: Duration of pain is a strong indicator of operative findings and thus patients outcome