Acute lower limb deep venous thrombosis diagnosed by doppler ultrasound among Bedridden patients

Background: Acute lower limb deep venous thrombosis [DVT] is a serious condition that could lead to venous thromboembolism [VTE]. Up to our knowledge, little is known about the risk factors for developing acute lower limb DVT in bedridden patients across Saudi Arabia. So we conducted this study aiming to determine the incidence and medical conditions that increase the risk for developing acute lower limb DVT in suspected cases of bedridden patients admitted in or referred to Radiology Department, King Abdul-Aziz University Hospital for lower limb Doppler ultrasound examination

Method: A cross sectional study of 83 patients admitted in or referred to KAU hospital during the year 2016 and underwent lower limb Doppler examination

Result: The reported incidence of lower limb DVT, after undergoing lower limb Doppler examination, in the suspected cases reviewed by Radiology Department, King Abdul-Aziz University Hospital in Jeddah was 13 [15.7%]. The cases of DVT was 76.9% women. Elderly was the highest risk factor of acute limb DVT as 53.8% were elderly patients, followed by diabetes 30.8%, hypertension 15.4% and cancer 7.7%, The effect of the studied risk factors on DVT was insignificant [P value >0.05]

Conclusion and recommendations: Lower Limb DVT has high prevalence [15.7%] in bedridden patients in Jeddah, KSA. Thrombophilia screening should be reserved for elderly, diabetics, hypertensive, and those with cancers or patients with other risk factors. Knowing the most common risk factors and their significance in developing DVT is essential for early detection of DVT to prevent the unwanted complications

Spina bifida in infants and children in Arar, Northern Saudi Arabia

Background: Neural tube defects [NTDs] are the most common birth defect of the central nervous system. Spina bifida [SB] is a common birth defect resulting from incomplete closure of the neural tube during the first month of pregnancy and that is associated with significant clinical complications that can affect survival and the quality of life for affected individuals

Objective: The study objective was to estimate the prevalence, types, manifestations, diagnosis, complications as well as treatment outcomes of of Spina bifida in all neonates born in Maternity and Children hospital in Arar city, Northern Saudi Arabia

Methods: This is a descriptive study involved all neonates born in Maternity and Children hospital in Arar city, Northern Saudi Arabia, KSA, during the period from 1 January to 31 December 2017. Data was collected by retrospective analysis of the recorded data and filling a pre designed questionnaire, which include questions designed to fulfill the study objectives

Results: The total number of spina bifida cases borne in maternity and children hospital in Arar city, Northern Saudi Arabia during the year 2017 was 14 cases with a prevalence of 0.51%; 8[57.1%] were females and 6[42.9%] were males. Consanguinity between parents found in 57.1% of cases, and folic acid deficiency during pregnancy reported in 78.6%. The site of spina bifida was lumbosacral in 57.1% and lumber 42.9%. The type was Spina bifida occulta 57.1%, Myelomeningocele 28.6% and Myeloschisis 14.3%. Weakness of legs, urinary incontinence 35.7%, hip dislocation, deformity of the body 21.4% and paralysis were the reported complications

Conclusion: The prevalence of spina bifida in Arar, KSA was 5.1per 1,000 live births. Majority of the reported cases were females, Spina bifida occulta was the most common then myelomeningocele and myeloschisis. The site was lumbosacral and lumber

Correlation of ultrasound and mammography to histopathology results in breast cancer. a one year study at King Khalid Hospital, Najran, Saudi Arabia

Objective: To compare the ultrasound and mammography results to histopathology reports of breast cancer cases presented in King Khalid hospital, Najran, Saudi Arabia, 2016

Methods: This retrospective cross-sectional analytic study was performed on 105 patients with breast lumps, who were referred to breast clinic King Khalid hospital Najran, during 2016. The patients' information was recorded using a checklist, which included name, code, age, ultrasonography, and mammography results and pathology reports. The results of ultrasonography and mammography were compared with histopathology. The results were analyzed on SPSS [version 16]

Results: The mean age of the patients was 42.3 [ +/- 5] years. Our results showed that in histopathology reports, in [30/105] patients i.e. 28.6% were malignant, 26 patients [24.8% ] biopsy revealed benign disease. Examination with mammogram revealed that, 33/105 i.e. [31.4%] were malignant and 40 cases [38.1%] had benign disease. On ultrasound examination, 21/105 [20%] were malignant and 43[40.1%] had benign disease. The mammography sensitivity was 76.6% and ultrasound sensitivity was 60%. Breast Imaging-Reporting and Data System [BIRADS] by mammogram revealed the categories as follows; category 0 in 21.9%, 2in 11.4%, 3 in 31.4, 4 in 5.7%], 4a in 6.7%, 4b in 4.8%, 4c in1.9%, 5 in 8.6% in 6 in 4.8% and unclear in 2.9% of cases. Retro areolar area was involved in 24.8%, Upper Outer Quadrant in 45.7%, Upper Inner Quadrant in 3.8%, Lower Outer Quadrant in 4.8%, Lower Inner Quadrant in 8.6%, Diffuse involvement in 9.5% and unable to pick in 2.9%. By mammogram, the calcification found revealed 15.2% of examined patients had malignant lesions. Findings of lymph nodes examination by mammogram revealed 5.7% of the examined patients had malignant lesions. Significant difference [P<0.05] regarding the age group was found in pathology and mammogram results

Conclusion: This study showed that mammography is the preferred diagnostic tool in screening early breast cancer patients aged above than 40 years with a higher sensitivity; the results are near to open biopsy. For the younger age group the use of ultrasonography in cases with high breast density is promising

Congenital hydrocephalus in Arar, Northern Saudi Arabia

Background: Congenital hydrocephalus, an important cause of neurologic morbidity and mortality in children, is a medical condition characterized by an abnormal accumulation of cerebrospinal fluid in the brain

Objectives: To estimate the prevalence and the recent progresses in diagnosis of hydrocephalus as well as the changes in epidemiology and treatment outcomes of the disease

Methods: This is a descriptive study involved all neonates born in Maternity and child hospital in Arar city, Northern Saudi Arabia, KSA, during the period from 1 January to 31 December 2017. Among 6000 delivered infant in 2017; there was 23 cases of hydrocephalus. Data was collected by using predesigned questionnaire which include questions designed to fulfill the study objectives

Results: the prevalence of hydrocephalus among studied infants was 0.38%. Consanguinity between parents was reported among 60.9% of the cases. Other congenital anomalies reported, cardiac anomalies 39.1%, spina bifida 17.4% and cleft palate 8.7%. Cause of hydrocephalus was 65.2% hereditary and 34.8% infection [secondary cause]. Swelling of the eyelid, increased vascular clarity on the skull, transparent skin in the head, the child's tendency to sleep, disorientation, irritability and nervousness, high crying, weakness of feeding and vomiting, delayed child skills, convulsions, increased size of the head, the sun's sign in the eye and the child is always looking down were the symptoms reported by the cases. 56.5% of the cases had shunt insertion and 43.4% had ordinary medical treatment. 30.4% of the shunt cases were complicated [17.4% had shunt blockage with infection and fever, 13% shunt blockage and 69.6% had other complications]. Outcome of the case; 39.1% were stable, 13% worsen and 47.8% died [34.7% died by complications, 8.7% during operation and 4.3% did not receive treatment]

Conclusion: The prevalence of hydrocephalus is comparable to that of other countries. More research is recommended because it is probable that the real prevalence of congenital hydrocephalus was underestimated and no account of how often abortions are performed among mothers of hydrocephalic fetuses. So more efforts from the ministry of health is needed

Predictors, complications and outcome of coronary artery bypass surgery patients attending the cardiac center of arar city, northern saudi arabia

Background: The increased incidence of cardiovascular disease between patients nowadays led to upsurge in the number of cardiac operations. After coronary artery bypass surgery, most patients remain free of symptoms for up to 15 years. The surgery also reduces the risk of heart attack and improves survival

Objective: to determine the predictors and outcome of coronary artery bypass surgery in patients attending the cardiac center in Arar, KSA all over the study period

Methods: The current study is a cross sectional study conducted during the period from September 2017 to March 2018. The current study included 72 individuals attending the cardiac center in Arar City. Collecting patients’ data was conducted through interviewing the patients included in the study and reviewing their medical files. A predesigned questionnaire was used for data collection

Results: We found that 81.9% of cases were males, 61.1% aged from 30 to 39 years old, 34.4% of cases have a myocardial infraction as a clinical diagnosis before the operation, 25% had angina pain, and 50.0% were smokers. Hyperlipidemia, chronic kidney disease, and chronic obstructive lung disease were found in 59.7%, 83.3% and 77.8% respectively. There were 41.6% who had postoperative arrhythmia, 13.9% had bacterial infection in the site of operation and another 13.9% had hypotension, 11.1% re-operated due to bleeding, and 6.9% got postoperative acute myocardial infarction. After 6 month of the operation, 69.4% of cases were quite good while recurrence of chest pain found in12.5%, heart failure in 2.8% and 8.3% died. There was significant association between outcome of cases after 6 months of operation and patients age [P<0.05] and all the dead cases were males

Conclusion: Our findings indicated that, among cardiac patients attending the cardiac center in Arar, KSA, the preoperative characteristics are suggestive of 30 to 39 years old males with myocardial infraction, angina pain, smokers, have hyperlipidemia, chronic kidney disease, and chronic obstructive lung disease is undergoing coronary artery bypass surgery. The death rate was low and 69.4% of cases were quite good

Prevalence and determinant factors of osteoarthritis of the knee joint among elderly in arar, ksa

Background: Osteoarthritis of the knee, the disease of knee joint dysfunction and pain caused by joint degeneration, it is the commonest joint disease. In most cases of joint degeneration there is no clear identifiable cause, but increasing age, excessive joint loading, and joint abnormalities and trauma increase the risk of OA. It has significant effects on human health and quality of life [QoL]

Objective: This study was carried out aimed to determine the prevalence and determinant factors of osteoarthritis of the knee among elderly population in Arar, KSA. Methods: The present cross sectional community based study was conducted in Arar city, the capital of Northern Borders Governorate on 238 elderly people of age 60 years and more. Data was collected through personal interviews with the sampled population and filling a predesigned questionnaire. It included questions regarding the already previously diagnosed osteoarthritis of the knee joint and its determinants

Results: the mean age [+/- SD] was 70.4 [+/- 9.3] years, male to female ratio was 48.3 to 51.7. The overall prevalence rate of osteoarthritis of the knee joint was 24.5%.Osteoarthritis was almost equal in females and males [26.8% and 26.1%, respectively], it was insignificantly associated with increasing age, female sex, hypertension and diabetes [P>0.05], while significantly associated with the BMI

Conclusion: Osteoarthritis of the knee joint is common among elderly population in Arar, KSA. It was almost equal in females and males

Risk factors, post-operative complications and outcome of management of hip fracture in arar, northern saudi arabia

Background: Hip fractures are defined as any fracture of the femur between the articular cartilages of the hip joint to 5 cm below the distal point of the lesser trochanter. Hip fracture is a worldwide public health problem that primarily affects osteoporotic individuals and the elderly. Up to 30 % of the elderly patients with a hip fracture die within the first year

Objective: to show the risk factors and post-operative complications of hip fracture in cases attending orthopedic department of Arar Central Hospital in Arar city

Methods: a cross sectional study conducted during the period from 1 December 2017 to 31 March 2018. A predesigned questionnaire was used for data collection, and included inquiries about sociodemographic data of the studied patients, performing muscular exercise, osteoporosis, diminished vision and disorders in equilibrium, causes of fracture, type and site of fracture, occurrence of complications of surgery, postoperative care and the final outcome of treatment

Results: Most [70.1%] of the studied population aged 22-59 years, males constituted 59.8%. Causes of hip fracture were accident in 66.7% and fall in 25.0%. Among hip fracture cases, 43.9% were obese, 13.1% have osteoporosis, and 17.8% have disorders in equilibrium. Males reported insignificant higher percentage of hip fracture than females [25.0% Vs. 18.6%]. Osteoporosis, diminished vision, chronic diseases, continuous use of medications and smoking showed significant relation with hip fracture [P<0.05]. While BMI, disorders in equilibrium and performing muscular exercise showed insignificant relation. Complications after surgery was osteomyelitis in 12.6%, early fixation failure in 4.2%, wound infections in 8.4% and hospital acquires pneumonia in 4.2%. Only two thirds of the cases were completely cured

Conclusion: in our study population in Arar city, males reported insignificant higher percentage of hip fracture than females. Osteoporosis, diminished vision, chronic illnesses, continuous use of medications and smoking were significant risk factors of hip fracture. Complications after surgery was included, osteomyelitis, early fixation failure, wound infections and hospital acquire pneumonia. Only two thirds of the cases were completely cured, the rest of cases showed disability and movement limitation

Cruciate ligament injury among students of northern border university, saudi arabia

Background: cruciate ligament consists of the anterior cruciate ligament [ACL] and posterior cruciate ligament [PCL] and they go from the femur to the tibia. The cruciate ligaments function is mainly to stabilize the knee and these ligaments have a risk to be injured in the athletes as well as non-athletes

Objective: address the prevalence of cruciate ligament injuries and its association with different types of injuries among Northern Border University students, Arar, KSA

Methods: A cross-sectional study was conducted among a representative sample of Northern Border University students in Arar City, Kingdom of Saudi Arabia, during the academic year 1439-1440. The students received the questionnaire to complete it. The parameters included in the questionnaire included age, sex, cause of cruciate ligament injury as during football playing, motor car accident, side and type of injury, type of treatment whether surgical treatment, physiotherapy or medical treatment

Results: This study reported the prevalence of cruciate ligaments injury among the studied Northern Border University students in Arar city, Kingdom of Saudi Arabia was 5.7%. The age of the studied ACL injury cases ranged from 18 to 30 years with mean age [+/- SD] was 23.0 +/- 4.2 years. Most of cases [98.6%] were males. Playing football was the most common cause by 78.9% followed by motorcar accidents 7%, fall from stairs 5.6%, swimming 4.2% and fall from height 2.8%. As regards the side of the injured cruciate ligament, 60.6% had anterior cruciate ligaments injury, 8.5% had posterior cruciate ligament injury, and 18.3 % had injury in both sides. In the majority [54.9%] of cases, ACL tear was complete; partial in 38.0%. 14.1% received medical treatment, surgical treatment and physiotherapy by the same percent 32.4%, medical treatment and physiotherapy 15.5%. As regards outcome of treatment, this study reported 74.6% of patients become good and stable, 23.9% still complaining and 1.4% suffering from disability

Conclusion: This study reported the prevalence of cruciate ligaments injury among the studied Northern Border University students in Arar city, Kingdom of Saudi Arabia was 5.7%. Most of cases [98.6%] were males. Playing football was the most common cause by 78.9% followed by motorcar accidents 7%. As regards outcome of treatment, this study reported 74.6% of patients become good and stable, 23.9% still complaining and 1.4% suffering from disability

Is ultrasound detect renal infections?

Objective: To asses culture and sensitivity of renal infection patients detected on ultrasound

Study Design: Prospective cohort study

Place and Duration of Study: This study was conducted at the Rimsha Medical Center Dadu from January 2012 to June 2015

Materials and Methods: Hundred patients suffering for renal infection detected on ultrasound were included in the study. Diabetic and urolithiasis patients excluded from the study. Urine culture and sensitivity of renal infection patients detected on ultrasound carried from collection point of diagnostic and research laboratory liaqaut university of medical and health sciences Jamshoro/Hyderabad in Dadu

Results: Out of 100 patients 65 [65%] were female and 35[35%] male. The age of the patients ranged from 15 to 45 years with mean age 28.9 SD +/- 8.8 The presenting features were lumbar pain with on and off fever in 60[60%] cases, dysuria in 15[15%], and in 35[35%] cases was asymptomatic. The renal infection detected in ultrasound bilaterally in 30[30%], Right sided in 35[35%], left sided in 25[25%] and chronic pyelonephritis [change of small size kidney with increase echogenicity and small size kidney with irregular border] in 10[10%] cases. culture and sensitivity seen positive in 27[27%] cases. Pyuria and haematuria seen in 17[17%]. The commonest micro-organism detected E.coli in 60[60%], Klebsiella 15[15%], Proteus 5[5%], Enterococcus 5[5%], staphylococcus saprophyticus 5[5%], streptococcus 7[7%], Pseudomonas 3[3%] and insignificant mixed bacterial growth seen in 7 cases. Drug senstivity seen in 100% with meronam, pipracilllin/tazobactam, aztreonam. Nitrofurantoin and amikacin 90% Amoxi- clavulanic acid in fusidic acid, ceftrixone, cotirmoxazole, ofloxin, cefuroxime, cefixime 75% and resistance pattern seen more in ceftazidime, gentamycin, ciprofloxacin and ampcillin

Conclusion: Renal infection detected on ultrasound even with insignificant pyuria and haematuria should not be neglected because having significant positive culture and sensitivity report findings

Primary neuroendocrine tumors

To evaluate clinical presentation and surgical out come of primary neuroendocrine tumors of Kidney, U. bladder and Prostate gland. A Retrospective study. Urology Department, SMBBMU Larkana. 2001-2011. Series of 6 patients of primary neuroendocrine tumors of Kidney, U. bladder and Prostate gland were identified from 1890 cases of urinary tract tumors. Two cases of renal carcinoid, two cases of small cell carcinoma of urinary bladder and two cases of small cell carcinoma of prostate glands. Renal carcinoid tumors presenting with lumbar pain and microscopic haematuria and identified on the ultrasound. Small cell carcinoma of urinary bladder presenting with dysuria, gross haematuria and on ultrasound while small cell carcinoma of prostate gland presenting with irritatory and obstructive symptoms and confirmed on DRE. 6 patients [5 male and 1 female],Mean age of patients were 45years and range was 35-55 years. All patients treated primarily by definitive surgery like Radical Nephrectomy, TURBT and Pallitive TURP and all tumors confirmed on histopathological examination and referred to LINAR Larkana for proper managements. primary neuroendocrine tumors of Kidney, U.bladder and Prostate gland are rare tumors. Carcinoid tumors have good prognosis but small cell carcinoma have poor prognosis so require prompt treatment

Medical colleges admission test in Punjab, Pakistan

Nearly 18,000 candidates securing 60% and above marks in Higher Secondary School Certificate [HSSC] examination contest for admission in Medical Colleges, in Punjab, Pakistan by sitting in the Medical College Admission Test [MCAT] each summer. This cross-sectional study was conducted to identify patterns related to demographic, economic and educational backgrounds, over a two-year-period, in this population, and how HSSC and MCAT marks predict future performance of the selected candidates. Marks obtained by candidates in HSSC, MCAT, and 1st Professional MBBS [Part-I] Examinations over two years 2008-2009, were analysed using parametric tests in SPSS. Total 18,090 candidates in 2008 and 18,486 in 2009 sat in the MCAT. National HSSC candidates scored higher marks in HSSC and MCAT but lower marks than their foreign qualified HSSC counterparts [e.g., Advanced-Levels from Cambridge University, UK] in Part-I overall and in all its subcomponents individually [p<0.05]. Female students scored higher marks than males in HSSC [p>0.05], MCAT [p>0.05] and Part-I theory, practical, viva voce, continuous assessment and Objective-Structured Performance Evaluation [OSPE] components [p<0.05]. In both years, students from the Dera Ghazi Khan District scored the highest marks in the HSSC Examinations [p<0.05] but least marks in MCAT in 2008 [p<0.05] and in Part-I in 2008 and 2009 [p<0.05]. Students from 'tougher' Boards like Rawalpindi in 2008 and the Federal Board in 2009 who scored least marks in HSSC scored highest marks in MCAT, and in Part-I Examinations [p<0.05]. Linear regression on Part-I by taking HSSC and MCAT marks as independent variables showed that the MCAT marks exerted the greatest positive influence consistently at 0.104 [2008] and 0.106 [2009]. In 2009 HSSC marks were shown to exert a negative influence [-0.08] on Part-I. There is need to standardise HSSC education and examination across all Intermediate Boards. MCAT is a better predictor of Medical Students' future performance

Giant hydronephrosis

To study the clinical presentation and management of giant hydronephrosis. Civil Hospital Dadu and Urology Department SMBBMU Larkana. March 2004 to March 2011. 28 patients with giant hydronephrosis treated. 18[64.3%] patients had unilateral and [27.1%] had bilateral pelvi ureteric junction obstruction, 4[14.3%] had ureteric stones and remaining 4[14.3%] had multiple renal stones. All patients were treated with definitive surgery ie pyeloplasty, nephroplication, ureterolithotomy, extended pyelolithotomy and nephrectomy. Six [21.4%] patients had elevated blood urea and serum creatinine level so initially treated by percutaneous nephrostomy and ureteric catheterization. 10 out of 28 cases of giant hydronephrosis showed improvement in the function and drainage as well as pelvi-calyceal system dilatation while 28 patients going for nephrectomy. Early referral and intervention is necessary for giant hydronephrosis to prevent infection and deterioration of renal function

Evaluation techniques in Punjab, Pakistan: eight years of reforms in health professional education

Pakistan, the most populated country in the WHO Eastern Mediterranean region has a population of over 170 million, spread over five provinces and four federally administered areas. It has a growth rate of 1.9%. Punjab is the most populous and developed province with an estimated population in 2010 of 81 million. In 2008, Punjab's development index of 0.60 and a literacy rate of 80% were the highest in the country. In Pakistan, the number of doctors and nurses has risen from 48 to 71 per 100,000 and from 16 to 30 per 100,000, respectively between 1990 and 2003. The major challenge, still, is the imbalance of the population to health-care workers ratio. At the time of creation of Pakistan, King Edward Medical College was the only fully functioning medical college. Over the years, as a result of health reform initiatives, a number of government medical colleges were established in the country. University of Health Sciences, Lahore was established in 2002, having sole jurisdiction over all medical, dental and allied health institutes in the province with the aim of moving medical education towards an outcome-based patient and community oriented competency-driven system. This paper attempts to clarify how initiatives and reforms in the evaluation process have helped the UHS realise its aims. Evaluation in all branches of higher education has long been taken as a means to an end. The focus of UHS on teacher-training, introduction of behavioural sciences as a compulsory subject and setting up an outcome-based evaluation process, has established a knowledge-acquisition medical education atmosphere. The challenges in the future relate to sustainability through capacity-building and staying abreast with the Best Evidence Medical Education practices worldwide, implementing them to fit our local needs and resources

Trans vesical prostatectomy; judging the symptoms severity and quality of life

To determine the effectiveness of prostectomy in reducing symptom severity and quality of life. A prospective study. Urology department civil hospital Dadu. 2005 to 2007. 100 men under going prostectomy were assessed using the American urological Association [AUA] symptom index score and quality of life. The adverse events like urinary incontinence, erectile dysfunction and retrograde ejaculation also detected. The outcome was assessed after 3 month of prostectomy. Prostectomy was effective in reducing symptoms. Initial mean IPSS was 25 and reduced to 7 with p value < 0.001. Quality of life also assessed which showed majority of cases were mostly satisfied. Adverse events like transient incontinence 10%, retrograde ejaculation in 65% and erectile dysfunction in 25% respectively. Prostectomy is effective in reducing symptom severity and improve quality of life which was detected by IPSS and quality of life questionnaire

Calculus anuria and its remedy

Urinary lithiases have been a major urological problem. The objective was to determine the out come of treatment for patients with calculus anuria. A descriptive study was conducted at Department of Urology Chandka Medical College Hospital, Larkana from March 2007 to April 2009. All patients with a diagnosis of calculus anuria of all ages and either sex were included in the study. Detailed history, physical examination and examination of genitourinary tract was performed. Investigations included complete blood examination, blood urea, serum creatinine, ultrasonography of KUB area, and X-Ray KUB. Among the 66 patients the cause of anuria was bilateral obstruction by the calculi in 46 cases, unilateral obstruction with small/absent/nephrectomised contralateral kidney in 20 cases. In most of the cases, ureteric catheterisation was done to relieve the obstruction. Five deaths were observed, despite emergency urinary diversion and appropriate treatment. Calculus anuria is a urological emergency. Prompt and early intervention can save the life of patient and prevent to develop chronic renal failure

Duckett urethropusty: technique in the management of distal hypospadias

To assess the efficacy, safety and complication of Duckett urethroplasty technique in the management of distal hypospadias. Prospective study. At Urology Department, Services Hospital Lahore and larkana. From 1 998 to 2007. Fifty patients of distal hypospadias were selected from the Urology Departmental services hospital lahore and larkana for duckett urethroplasty technique. Age of the patients ranged from 5 to 22 years. The mean age was 1 0 years, forty [80%] patients belonged to urban areas while 10 [20%] were of rural areas.AII the patients presented with dystopia of external urethral meatus and chordee [ventral curvature]. 25 [50%] presented wih misdirected stream, spraying of urine 3 [5%] and narrow stream 3[5%]. The subcoronal type of distal hypospadias was commonly seen in our study. Forty [80%] patients had subcoronal and 10 [20%] distal penile urethral opening. All the patients were had distal type of hypospadias associated with chordee. Following duckett technique 32 [64%] patients had good result and 10[20%] patients have fair result while 8[1 6%] were decleared as a failed cases. There is still no operative procedure.which can be labelled as ideal operation for hypospadias.however duckett technique have lower success rate but statistically insignificant as compared to other procedures

Minimally invasive approach for paediatric ureteric calculi

To find out the efficacy and safety of ureteroscopy in the management of paediatric ureteric calculi in terms of stone clearance rate and hospital stay. Descriptive study. Department of Urology Chandka Medical College Larkana, From January 2006 to October 2008. All children with ureteric calculi were thoroughly examined. Blood CP, blood urea, serum creatinine, ultrasound KUB and IVP were carried out in all. They underwent URS. 8.5 FR [Wolf] ureteroscope was used. Stones were broken down with Swiss lithoclast There was no rigid protocol for placement of ureteric stent but ureteric catheter was placed in all. Follow up x-ray KUB was done in all the children to find out the clearance of stone fragments. During the study period nineteen children with mean age of 7 years [range - 5 year to 12 years] having ureteric calculi of 7 mm to 1.2 cm [average size - 1cm] were managed. In most of the cases the stone were in the lower one third of the ureter. Presenting symptoms were abdominal pain in 7 [36.84%], dysuria in 4 [21.05%], haematuria in 3 [15.79%] and recent episodes of urinary tract infection in 5 [26.32%] children respectively. In 10 [50.54%] calculi were on right side. In 17 patients stones were located in lower 1/3 while in 2 patients stones were present in both the ureters. In two patients repeat ureteroscopy was required as initially ureteroscope could not be negotiated hence ureteric catheter was left for 48 hours. Successful stone clearance was achieved in 95%. One child developed haematuria. No long term complication was found during the study. Ureteroscopy is safe and effective management for ureteric calculi in children

Distal hypospadias; Barcat-Redman urethroplasty

To assess the efficacy, safety and complication of Barcat-Redman urethroplasty technique in the management of distal hypospadias. Prospective study was completed at Urology Department, Services Hospital Lahore and Larkana from 1998 to 2007. Fifty patients of distal hypospadias were selected from the Urology Department of Services Hospital Lahore and Larkana for Barcat-Redman urethroplasty technique. Age of the patients range from 5 to 25 years. The mean age was 11 years. Forty [80%] patients belonged to urban areas while 10 [20%] were of rural areas. All the patients presented with dystopia of external urethral meatus and chordee [ventral curvature] while 25 [50%] presented with misdirected stream, 3 [5%] spraying of urine and 3 [5%] narrow stream. The subcoronal type of distal hypospadias was commonly seen in our study. Forty [80%] patients had subcoronal and 10 [20%] distal penile urethral opening. Following barcat-redman technique 35 [70%] patients had good result and 8 [16%] patients were declared as fair result while 4 [14%] declared failure. The overall morbidity rate was 30% while hospital stay was 3 days. Barcat-Redman urethroplasty technique is simple, less time consuming and has success rate for the management of Distal hypospadias

Extracorporeal shock wave lithotripsy; Efficacy of in situ echoguidance in upper and lower ureteral calculi

amanullah7860@yahoo.com. To assess efficacy of ESWL as a single modality in upper and lower ureteric calculi. department of Nephro-Urology Chandka Medical College Hospital, Larkana. January 2003 to April 2006. 62 patients underwent ESWL. Upper and lower ureteral calculi were treated by using Dornier MPL-9000 Lithotripter with ultrasound localization. Among 62 cases 56[90.3%] patients had upper ureteric calculi, whereas 06[9.7%] patients had lower ureteric calculi. Size of stones ranged from 0.5 mm to 18mm having mean size of 10mm. All patients were followed for period of 6 weeks. Of these 62 patients 58 patients were stone free at the end of 2 weeks follow up. In 2 cases stones failed to fragment, where as 2 cases failed to attend out patient department for follow up. This study concluded that in situ echoguided ESWL was effective modality of treatment for upper and lower ureteric stones. Localization of ureteric stones with ultrasound has the advantage of elimination of radiation exposure to the patient and lithotripsy team

Vesico-vaginal fistula experience of surgical repair at Larkana

To assess the causes of Vesico-vaginal fistula and evaluate the results of surgical repair ot'Vesico-vaginal fistula A retrospective study was conducted in Ch and ka Medical College Hospital and Larkan Medical Centre from March 1999 to February 2005. Forty patients of Vesico-vaginal fistula resulting from causes other than malignancies and radiations were included in the study. Majority of the patients had fistula secondary to an obstetrical cause. Of the total 32 patients were repaired trans-vaginally. Prolonged labour was the major cause of Vesico-vaginal fistula [80%]. Thirty two [80%] patients were operated trans vaginally and 8 trans-abdominally. Success rate was 85.8% for the transvaginal approach in the first instance. Stress urinary incontinence was noted in 2 patients while 1 patient with transabdominal approach developed recurrence. In developing countries the major cause of Vesico-vaginal fistula is obstructed labour which can be repaired trans. vaginally in majority of cases under skilled surgeon