Frequency of post dural puncture headache in patients undergoing elective cesarean section under spinal anesthesia with median versus paramedian approach

Objective: Post dural puncture headache [PDPH] is one of major complications of spinal anesthesia. There are two approaches to administer spinal anesthesia i.e. median and paramedian. We conducted this study to compare the frequency of PDPH after spinal anesthesia for cesarean section with median versus paramedian approach using 25 gauge pencil point needle

Methodology: This randomized controlled trial was conducted at Departments of Anesthesiology, Surgical Intensive Care and Pain Management Centre as well as Gynecology and Obstetrics, Peoples University of Medical and Health Sciences, Nawabshah, Benazirabad [Pakistan]. One hundred and twenty females underwent elective cesarean section under spinal anesthesia were enrolled. After informed written consent, the parturients were randomly divided into two equal groups by lottery method; Group A patients received spinal block with median approach and Group B patients received it with paramedian approach. All spinal blocks were performed with 25 gauge pencil point needle. The patients were asked about the presence or absence of headache through Visual Analogue Scale [VAS] in the next 72 hours

Results: In median approach [Group A], 3 patients [5%] had PDPH; whereas in paramediannapproach [Group B] only 1 patient [1.6%] had PDPH. All the patients were of younger age and low parity. They developed PDPH within 24 -48 hours which was of mild to moderate in degree on VAS and relieved by rest, plenty of fluids and simple analgesics containing caffiene in mild case. While strong analgesics and muscle relaxants were added in cases of moderate PDPH. PDPH was relieved within 2-3 days in all cases without any complication. The difference was statistically insignificant [p-value=0.30]

Conclusion: Paramedian approach is better than median approach in terms of reduction in the frequency of PDPH, though the results were statistically insignificant?

comparative study of trans urethral resection versus trans urethral incision for small size obstructing prostate

To compare the results of transurethral resection of prostate [TURP] with transurethral incision of prostate [TUIP] for small size obstructing prostate. Comparative study. Department of Urology, Peoples University of Medical and Health Sciences for women Hospital Nawabshah, from 2008 to 2010. Patients were divided in TURP and TUIP groups with fifty patients in each. Patients of any age with small size [thirty grams or less] prostate needing surgical intervention were included. TURP was done with conventional technique. In TUIP two deep incisions were made at 5 and 7'O clock positions of the bladder neck using Collings knife. Pre-per and postoperative variables were observed and recorded. All patients were followed up to six months post operatively. A total of 100 patients were included in the study. Mean operative time was 12.4 minutes in TUIP and 22.6 minutes in TURP. Retrograde ejaculation and blood transfusions were less in TUIP than TURP. The improvement in maximum flow rate improved in both the groups. TUIP is as effective as TURP in achieving maximum flow rate but TUIP was superior in terms of shorter operative time, less retrograde ejaculation and less need of blood transfusion

Pattern of intestinal obstruction in infants and children

To find out causes of intestinal obstruction in infants and children and their relation to age and sex distribution. This descriptive study was conducted at Peadiatric Surgery departments of Peoples University of Medical and Health Science for women Hospital Nawab Shah and Liaquat University of Medical and Health Sciences Hospital Jamshoro, from January 2010 to December 2010. All infants and children presenting with symptoms and signs of intestinal obstruction, and patients having advanced appendicitis with intestinal obstruction, were included in this study. Surgical intervention was carried out, where indicated, otherwise patients were managed conservatively. Patients were divided into two groups: Infants were enlisted in group A, while toddlers and older children were put together in group B. Data was analyzed by using SPSS version 10 for percentage and frequencies Total 67 patients were included in the study. Among these 44 were Males and 23 Females with M: F ratio of 1.9:1. There were 24 patients in group A, among these, 15[62.5%] cases had intussusception, while other conditions, namely incarcerated inguinal hernia, colonic web, post operative adhesions, ileal web and inflammatory bands constituted 37.5% cases of bowel obstruction. In group B there were 43 patients. These included, post operative adhesions in 6[13.95%] patients, while tuberculosis of intestine in 5[11.63%], Meckel's diverticulum with band 5[11.63%], perforated appendix in 5[11.63%], intussusception in 3[6.97%], Volvulus of small intestine in 3[6.97%] and Inflammatory bands and adhesions in 3[6.97%] patients. Malrotation, Hirschsprung's disease, Trichobezoar and faecal impaction each one occurred in 2[4.65%] patients. Ovarain teratoma, lymphoma, caecal Volvulus, duodenal web and duplication of colon of each one of these conditions occurred in one [0.43%] patient each. Resection of gut and anastomosis was carried out in 18[26.86%] patients [8 from group A and 10 from B]. Two patients from group B died. Pattern of intestinal obstruction varies at different age groups in terms of etiology as well as in relative incidence. Intussusception was the commonest cause in group A, while post operative adhesion had predominance in group B. Outcome depends upon the underlying condition and associated morbidity

Colostomy in children: indications and complications

To determine the indication and frequency of complications occurring with construction of colostomy in children. This descriptive study was conducted at Paediatric Surgery department of PMC Hospital and at Mumtaz Medical Center [Pvt.] Nawab Shah, from April 2008 to December 2009. All patients who required colostomy as the part of management were included in this study. The patients who were operated upon previously or elsewhere and were referred after having colostomy, were excluded. In all patients loop colostomy was performed. Complications after colostomy construction were noted on a proforma. Thirty- seven colostomies were created in 36 patients. Sigmoid loop colostomies were 51.35%, Right and left transverse colostomies in 24.32% each. All patients were operated due to congenital anomalies. Twenty-eight patients had anorectal malformation and 8 Hirschsprung's disease. Common Complications related to stoma were excoriation of skin 58.82% and prolapse of stoma [50%]. Anaemia due to chronic blood loss was seen in 53.33% of patients. Transverse loop colostomy had higher number of complications / problems as compared with sigmoid loop colostomy. Five [13.88%] patients died [Three because of septicaemiae, one because of high grade fever at home, and one died on 2nd of PSARP, the cause could not be ascertained. Construction of colostomy in paediatric patients carries high frequency of complications and requires careful technique. A sigmoid loop colostomy is an ideal as it has minimal complications. Stoma care clinic and enterostomal therapist can be helpful in educating families for stoma care and to decrease the incidence of complications