Effectiveness of the ligation of intersphincteric fistula tract in the treatment of high lying perianal fistula

Background: Intersphincteric fistula may be ligated during surgery of high lying perianal fistula

Objective: To evaluate the effectiveness of the Intersphincteric ligation technique of the fistulous tract in the treatment of high lying anal fistula

Methodology: Study Design. Quasi Experimental study. Study Setting: Surgical deptt- II BVH Bahawalpur. Sampling Technique: Non-probability purposive sampling. Duration: 1 February to 31 July 2016. A total of thirty patients were recruited for this study, of high lying perianal fistula, and transsphincteric variety. Diagnosis verified by EUA, fistulogram and by MRI. They were subjected to ligation of Intersphincteric fistula tract on elective operation list. All these patients were observed in ward meticulously for 5 days then discharged and follow up done on OPD basis for 3 month for recurrence of fistula and for development of complications like incontinence. The data was entered and analyzed by using SPSS version 20

Results: Twenty five patients were cured. Only 5 patients were declared of recurrence of fistula, all 5 patients were having abscess cavity and that's why fistula tract have not healed. No patient presented with incontinence. The effectiveness of LIFT procedure remained about 83% in this model

Conclusion: The Ligation of Intersphincteric Fistula Tract [LIFT] technique in mid-term evaluation is effective for the treatment of high lying anal fistula

Adherent placenta Previa; outcome of abnormally

Abnormally adherent placenta is a condition in which all of part of the placenta is adherent to the uterine wall because of myometrial invasion by chorionic villi. In majority of cases chorionic villi are in contact with the myometrium i.e. placenta accretes. To detect the prevalence of morbidity adherent placenta and its outcome in terms of maternal morbidity and mortality. Over one year from October 2006 to October 2007. Gynaecology Unit-ll, Nishtar Hospital, Multan. All women who had pregnancy complicated by morbidity adherent placenta were identified and their case notes retrieved. Information was collected on a prescribed Performa designed for this purpose. There was 2114 deliveries during the study period in labour ward of Nishtar Hospital, Multan. Eight women fulfilled the study criteria. The prevalence was found to be 0.4%. Complications were PPH, acute renal failure, depression, cellulities of wound site and UTI. Due to rising rate of LSCS in present era, the prevalence adherent is also on raise

Frequency of retinoblastoma according to age, gender and laterality

Objective: To evaluate the frequency, age, gender and laterality related distribution of retinoblastoma. Study design: Cross sectional study

Place and Duration of study: This study was conducted at the Department of pathology BMSI, JPMC Karachi from 1[st]Jan 2009 to 31[st]Dec2013

Materials and Methods: A total of 80 cases of retinoblastoma were received in the department of Pathology, BMSI, JPMC, Karachi during the period of 1[st]January 2009 to 31[st] December 2013. The cases were reviewed and morphological diagnosis done on H and E. Information regarding laterality of lesion, age and sex were recorded from archives. The data analyzed by using SPSS version22

Results: Frequency of retinoblastoma was 2.93%. Right sided lesions were 46.25% and 45% were Left sided, with a M: F ratio of 1:1. The mean age of retinoblastoma patients was 3.64 years. It was relatively more common in 3 to 4 years [53.75%] of age group compared to other age groups

Conclusion: Frequency of retinoblastoma was 2.93%, with almost equal i-e 46.25% Right, 45% Left sided origins. The M: F ratio was 1:1 while more common age group was 3 to 4 years

Evaluation of union of neglected femoral neck fractures treated with free fibular graft

To evaluate the frequency of union of neglected femoral neck fractures treated with free fibular graft. Descriptive case series. Department of Orthopedics Bahawal Victoria Hospital Bahawalpur, from April 2009 to January 2010. Patients of neglected femoral neck fracture [one month postinjury] were included in the study. They were operated and internal fixation was done with concellous screws and free fibular graft placed. They were followed till the evidence of radiological union. Out of 55 patients there were 40 males and 15 females. Ages ranged from 20 year to 50 year. The duration of injury was from 4 weeks to 6 months. Fifty patients achieved complete union while five patients developed non-union with complaint of pain. There was no wound infection and hardware failure. Fracture reduction and internal fixation with use of free fibular graft and concellous screws for neglected femoral neck fractures is the treatment of choice

Evaluation of oral hygiene instructions given to orthodontic patients by general dental practitioners of Sindh

This study was conducted to evaluate oral hygiene instructions given to orthodontic patients by general dental practitioners of Sindh. Questionnaire proforma were given to 120 general dental practitioners [GDPs] who are doing independent clinical practice in Hyderabad and Karachi regions. Data were analyzed by using Statistical package for social sciences [SPSS-16.0]. The results of this study showed that 45.8% GDPs prescribed specific orthodontic brush, 27.5% ordinary manual tooth brush and 10% power [electrical] brush for plaque removal. 60% advised brushing in the morning, evening and at night. For inter-dental cleaning 22.5% advised interdental brush and 19.2% dental floss. 52.5% also occasionally prescribed mouth wash as an adjunct for maintaining good oral hygiene. According to the results of this study it could be stated that every GDP in Hyderabad and Karachi was giving oral hygiene instructions to orthodontic patients after placement of orthodontic appliance. Practitioners who have more clinical experience were better in giving oral hygiene instructions, but still they need more information and awareness to enable them to properly instruct the orthodontic patients

Fetal biometry in correlation with ultrasonographic appearance and measurement of epiphyseal ossification centres of fetal peripheral long bones for assessment of gestation age in the third trimester

To determine the correlation between fetal biometry and ultrasonographic appearance and measurement of epiphyseal ossification centres of fetal peripheral long bones for assessment of gestation age in the third trimester. Descriptive, observational study. This study was carried out at Department of Radiology, Dow University of Health Sciences/Civil Hospital Karachi, from February, 2009 - July 2009. 200 pregnant females were examined having gestational age of 28 or more weeks. Obstetrical ultrasound was done using 3.5 MHz convex transducer on Toshiba ultrasound scanner model Nemio-17. Measurement of Biparietal Diameter, [BPD], femur Length [FL] and abdominal Circumference [AC], placental localization and assessment of liquor was done as per standard protocol. The distal femoral, proximal tibial and proximal humeral ossification centers were identified and measured. Appearance and size of distal femoral, proximal tibial and the proximal humeral epiphyseal ossification centers in correlation with fetal biometry is helpful in accurate assessment of gestational age in the third trimester. Ultrasonographic visualization of the epiphyses ossification centers in correlation with fetal biometry is a useful marker of fetal gestational age in the third trimester

Fetal biometry in the third trimester; local perspective

To observe the frequently used parameters of fetal biometry along with ultrasonographic appearance and measurement of epiphyseal ossification centres of fetal peripheral long bones in our local population for assessment of gestation age in the third trimesster. Descriptive, Observational study. This study was carried out at Department of Radiology, dow University of Health Sciences/ Civil Hospital Karachi from February 2009 to July 2009. 200 pregnant females were examined having gestational age of 28 or more weeks. Obstetrical ultrasound was done using 3.5 MHz convex transducer on Toshiba ultrasound scanner model Nemio-17. Measurement of Biparietal Diameter, [BPD], femur Length [FL] and abdominal Circumference [AC], placental localization and assessment of liquor was done as per standard protocol. The distal femoral, proximal tibial and proximal humeral ossification centers were identified and measured. The frequently used parameters of fetal biometry along with ultrasonographic appearance and measurement of epiphyseal ossification centres of fetal peripheral long bones for assessment of gestation age in the third trimester in our local population are in agreement with international studies. Ultrasonographic visualization of the epiphyses ossification centers in correlation with fetal biometry is a useful marker of fetal gestational age in third trimester

Ultrasonographic appearance and measurement of epiphyseal ossification centres of fetal peripheral long bones for assessment of gestation age

To determine the ultrasonographic appearance and size of epiphyseal ossification centers of fetal peripheral long bones for assessment of third trimester gestational age. Descriptive, Observational study. This study was carried out at Department of Radiology, Dow University of Health Sciences/Civil Hospital Karachi, from February 2009 from July 2009. 200 pregnant females were examined having gestational age of 28 or more weeks. Obstetrical ultrasound was done using 3.5 MHz convex transducer on Toshiba ultrasound scanner model Nemio-17. Measurement of Biparietal Diameter, [BPD], femur Length [FL] and abdominal Circumference [AC], placental localization and assessment of liquor was done as per standard protocol. The distal femoral, proximal tibial and proximal humeral ossification centers were identified and measured. Gestational age correlated well with appearance and size of distal femoral, proximal tibial and the proximal humeral epiphyseal ossification centers but even better with the sum of the three ossification centers. Ultrasonographic visualization of the epiphyses ossification centers may be a useful marker of fetal gestational age

Health impacts of coal mining in baluchistan

To study the health impacts of coal mining on coal miners in Baluchistan. The data on coal miners was collected from May 2008 to April 2009. Two types of data were collected. Primary data was obtained through topographic survey and questionnaire while Secondary data about the health issues, medical facilities and other allied facilities of coal mine workers of Baluchistan were collected from; Mine and Mineral department of Quetta, hospitals and medicals facilities in coal mine fields. Three mine fields i.e. Mach, So-range-Degari, and Chamalong coal fields were selected and further subdivided as Ml,M2,andM3 at Mach coal field, SD1, SD2 and SD3 at So-range-Degari and Cl, C2 and C3 at Chamalong coal field. The average emission of Methane [CH[4]], Carbon monoxide [CO], and Oxygen [O[2] in coal mine fields was 11.8m[3] / ton, 36ppm and 14% respectively which, exceeded the permissible limits of l-10m[3], 30ppm and 18%. The concentration of coal dust [Carbon and Quartz] was 4-5mg/m[3] and 0.35mg/m[3] respectively as against the threshold limits of 2mg/m[3] and 0.05-0.1 mg/m[3] for 8 hours daily and 40 hours/week. Due to high concentration of coal dust the miners experienced headache, irritation in throat, nose and eyes, drowsiness, shortness of breath, nausea, pneumoconiosis, tuberculosis, chronic obstructive bronchitis, heart problems, and other respiratory illnesses. The coal water and slurry was disposed off in an unconfined area causing contamination of drinking water leading to symptoms of indigestion and diarrhea to the miners. Government of Baluchistan and coal mine owners should take concrete steps to improve the adverse health impacts of coal miners

Post operative analgesia following open cholecystectomy; is intermittent epidural bupivacain bolus administration more effective than continuous administration?

Pain following surgery is a universal phenomenon; it is often underestimated and undertreated. Epidural analgesia is considered to be the best method of pain relief after subcostal cholecystectomy. Epidural is effective technique that offers comparable analgesia and better side effect profile. Quasi Experimental study. Jan2010 to June 2010. Military Hospital Rawalpindi. This is a prospective, randomized control trial. The main objective of this study was to compare the number of rescue doses for postperative pain relief, after subcostal cholecystectomy under epidural anesthesia, in patients receiving continuous epidural infusion of bupivacain 0.125% with those receiving intermittent boluses. Thoracic epidural catheter was placed for post operative pain relief. Patients were divided into two equal groups. Patient receiving continuous epidural anaesthesia were placed in group A and those receiving intermittent doses were included in group B. Purposive [non probability] sampling. Patient who received intermittent boluses [group B] required less rescue doses of nalbuphine as compared to the patients who received continuous infusion of 0.125 bupivacain. Intermittent boluses of 0.125% bupivacain are considered a better method of postoperative pain relief than continuous infusion of 0.125% bupivacain

Diabetic hand; management

A case series study held at surgical unit 1. BV Hospital Bahawalpur. Study was conducted from June 2006 to May 2009, to evaluate various aspects of diabetic hand and to establish a protocol to manage it. All diabetic patients presented with hand infection to the unit during this time were included in the study but patients having classical diabetic hand syndrome were excluded. Total 48 patients were admitted during the period under review. Male to female ratio was 2:1 and age was ranged from 31 to 48 years. Data was collected on Performa and shifted to computer program SPSS version 12. All patients were manual workers or house wives and 40 patients gave history of minor trauma to the digits during work. All patients were either undiagnosed [16 patients] or had uncontrolled diabetes. Most of them delayed seeking advice for their trauma and infection of hand properly. During treatment, 30 patients [62.5%] required amputation of one or more digits of the dominant hand including amputation of thumb in 19. Only 4 patients [8.33%] ended up in amputation of hand, whereas, no patient required amputation of forearm. No mortality was seen during study period. It was concluded that diabetic hand involves persons in active life period relatively in younger age group. Undiagnosed or uncontrolled diabetes is major contributory factor. Health education, early diagnosis and prompt treatment in specialized units may be helpful

Pretreatment with lignocaine: effects on pain of rocuronium injection and withdrawal movements of the arm

To assess the frequency of pain and withdrawal movements after injection of rocuronium and effects of pre-treatment with lignocaine. Double blind study. This study was of six months duration and was carried out from March 2004 to September 2004. Combined Military Hospital Kharian. One hundred and twenty unpremedicated patients with ASA grade I and II, aged between 18-60 years and of both sexes were enrolled in the study. Patients were randomly divided into two groups of 60 patients each. After induction of anaesthesia with thiopentone, patients in group A received 3 ml of lignocaine plain while those in group B, received 3 ml of normal saline as pre-treatment before injection of rocuronium. Their effects on pain on injection and withdrawal movements of the arm were studied. Out of total of 120 patients, only 17 patients [14%] developed withdrawal movements of the arm or wrist. In Group A, who received lignocaine plain before rocuronium injection, only 3 patients out of 60 patients had withdrawal movements while in Group B, who received normal saline as pre-treatment fourteen out of 60 patients developed withdrawal movements of the arm or wrist. Only one patient belonging to Group B experienced pain. Pretreatment with lignocaine plain greatly reduces the chances of withdrawal movements and pain on injection of rocuronium

Clinico-pathological profile and outcome of inhalational burns

To determine clinico-pathological profile and outcome of inhalational burns in a specialized burns treatment unit. Case-series. The Department of Plastic Surgery and Burns Centre Unit, Combined Military Hospital, Kharian Cantonment in March 2005. Patients of inhalational burns were included and evacuated within 30 hours of accident to the specialized burns centre after immediate resuscitation. Total Body Surface Area [TBSA] involved in burns was calculated. Complete blood count and renal profile along with serum albumin and total proteins was obtained. Portable chest radiographs and bronchoscopic examination was conducted. Escarotomies were carried and wounds were covered with split thickess skin grafts. Ventilatory support was used as needed. Comparison of the clinico-pathological profile of surviving and fatal cases was done for significance using t-test. There were 19 patients of inhalational burns, 8 [42%] of whom expired. The mean percentage of TBSA in 11 surviving patients was 50 +/- 10.87 and 70 +/- 15.46 in fatal cases. The mean haemoglobin [Hb] on admission was 15.8 +/- 1.6 g/dL and after fluid resuscitation it became 11.4 +/- 1.5 g/dL. The mean Total Leucocyte Count [TLC] in surviving patients was 9.6 +/- 6.1x10[9]/L and 1.5 +/- 2.3x10[9]/L in fatal cases [p=0.001]. The mean platelet count of surviving patients was 205 +/- 63x10[12]/L while in fatal cases was 58 +/- 48x10[12]/L [p=0.05]. The serum urea levels in surviving patients was 4.3 +/- 2 mmol/L while in fatal cases was 8.6 +/- 0.9 mmol/L [p=0.05]. The serum creatinine levels were 98.2 +/- 16.5 micro mol/L in the survivor group and 249.5 +/- 76 micro mol/L in the mortality group [p=0.05]. The serum total protein in surviving patients was 63 +/- 8 g/dL while in mortality cases it was 57 +/- 7 g/L. Serum albumin in the survivor group was 36.7 +/- 5 g/L and 35 +/- 4 g/L in fatal cases. Significant in Hb, protein and albumin levels. All the expired patients had acute respiratory distress syndrome while acute renal failure with multi-organ failure co-existed in 6 patients. Inhalational burns injury cases multi-system injury with high mortality. Body area involvement, total leucocyte count, platelet count, serum area and serum creatinine are important indicators of survival

Acute parapharyngeal abscess secondary to streptococcal mastoiditis

A rare case of parapharyngeal abscess caused by Streptococcus pneumoniae presenting as neck abscess is reported. The patient had 20 days history of cough, fever and swelling behind right ear. He had not responded to multiple antibiotic treatments given earlier. On the basis of clinical examination and CT scan finding, he was diagnosed as having parapharyngeal abscess pointing in the neck. The abscess was drained and the patient was treated with injectable Ceftriaxone, due to identification of penicillin - resistant Streptococcus pneumoniae

Effects of pre-treatment with lignocaine on pain of rocuronium injection and withdrawal movements of the arm

The study was carried out to assess the frequency of pain and withdrawal movements after injection of rocuronium and effects of pre-treatment with lignocaine. It was a double blind study. This study was of six months duration and was carried out from March 2004 to September 2004 at Combined Military Hospital Kharian. One hundred and twenty unpremedicated patients with ASA grade I and II, aged between 18-60 years and of both sexes were enrolled in the study. Patients were randomly divided into two groups of 60 patients each. After induction of anaesthesia with thiopentone, patients in group A, received 3 ml of lignocaine plain while those in group B, received 3 ml of normal saline as pre-treatment before injection of rocuronium. Their effects on pain on injection and withdrawal movements of the arm were studied. Out of total of 120 patients, only 17 patients [14%] developed withdrawal movements of the arm or wrist. In Group A, who received lignocaine plain before rocuronium injection, only 3 out of 60 patients had withdrawal movements while in Group B, who received normal saline as pretreatment, fourteen out of 60 patients developed withdrawal movements of the arm or wrist. Only one patient belonging to Group B experienced pain. Pre-treatment with lignocaine plain greatly reduces the chances of withdrawal movements and pain on injection of rocuronium

comparison of sevoflurane with midazolam to provide sedation to patients for surgery under locoregional anaesthesia

To compare the quality, speed of recovery, and side effects of sevoflurane sedation compared with intravenous midazolam. Quasi experimental, double-blind, comparative study. Operation theatre complex, Combined Military Hospital Rawalpindi from 1st June 2006 to 31st Dec 2006. Total of sixty patients, American Society of Anaesthesiology I-III aged 18-70 years undergoing surgery under locoregional anaesthesia were divided into two equal groups by convenient sampling. Group A: [n=30] received Sevoflurane sedation. Group B: [n=30] received Midazolam sedation. The patients were sedated gradually during the procedure and maintained at Observer`s assessment of alertness and sedation [OAAS] score of 3. At recovery the OAAS score was measured at 5, 10 and 30 minutes after stopping the drug administration. Subjective assessment of quality of recovery was measured by visual analog scale [VAS] determined at baseline and 5, 10, and 30 min of recovery. On observer`s assessment of alertness and sedation score no significant difference was observed between the two groups in the first 10 min after drug discontinuation but after 30 min allpatientsin group A and 26 out of 30 patients in group B had returned to an OAAS of 5 [p= 0.039]. Subjective recovery as assessed by VAS scores showed that patients were more awake, had higher energy level, were less confused and better coordinated in group A sedation at 10 and 30 min post-procedure as compared to midazolam group B. Sevoflurane for sedation produced faster recovery as compared to intravenous midazolam measured by OAAS score and subjective assessment on VAS scale. However, sevoflurane is complicated by a high incidence of intra-operative excitement

Anaesthestic management in disasters an anaesthetist's experience in "LAMNO" banda ache, Indonesia

The purpose of this study is to highlight the problems faced by the anaesthesiologist in the field and to mention some of the anaesthetic techniques which have proved useful in such adverse circumstances. Responding to the call for help to the victims of Tsunami on December 26 2004, the Pakistan Field hospital [Level II] arrived in Sumatra [Indonesia] and was deployed in a remote island, Lamno, Banda Ache. A total of 11,299 patients were treated including 1164 surgeries, from 12[th] January 2005 to 26[th] February 2005. The main problems were non availability of pressurized oxygen source, hostile and adverse circumstances, language barrier and massive number of tsunami victims requiring immediate medical attention. The Boyle's apparatus could not be used as it requires high pressure gases at 40 to 50 psi. The Oxygen concentrator was the only source of Oxygen. Descriptive. The surgical patients mostly had wounds of extremities which were infected. Majority of the surgical procedures included debridements of the wounds, skin grafting and amputation of the extremities. Most of the surgeries were performed under local and regional anaesthetic techniques. A modified general anaesthetic technique using an oxygen concentrator was devised for those few patients where regional anaesthetics alone were inappropriate. Local anaesthesia was administered to 1055 [90.64%] patients with minor injuries; peripheral regional blocks were administered to 35 [3.0%] patients, spinal anaesthesia to 31 [2.66%] patients and extradural anaesthesia to 17 [1.46%] patients. Eighteen [1.546%] patients were operated under dissociative anaesthesia with Ketamine and 08 [0.687%] patients were administered total intravenous anaesthesia, muscle relaxants, endotracheal intubation, bag valve mask [Ambu's] ventilation, oxygen supplementation from the oxygen concentrator and local anaesthetic infilteration. The incidence of complications was very low and none of the surgical patients had anaesthesia related morbidity or mortality. Most of the Tsunami affected patients could be managed safely under local anaesthesia, regional blocks or dissociative anaesthesia with Ketamine. The oxygen concentrator proved to be highly useful source of oxygen for a modified general anaesthetic technique without using a proper anaesthesia machine

Role of distant flaps in soft tissue defects of the hand

To evaluate the role of different distant [groin, hypogastric] flaps in soft tissue defects of the hand. Design and Observational case series from Jan. 2002 to Jan. 2005.Bahawal Victoria Hospital, Bahawalpur.32 patients, 28 males and four females with large skin defects on hand due to agricultural machine injury 16], road traffic accidents [8], blast injuries [6] and electric burns [2].In 18 cases groin flap while in 14 cases hypogastric flaps were employed to cover the defects. Results: Two flaps were lost completely, partial flap loss occured in one, marginal necrosis in three, while infection was noted in one case.Distal flaps are useful for the coverage of the soft tissue defects of the hand when applied with proper. indications