Strangulated paraesophageal hiatus hernia: a case report

Strangulation of hiatus hernia is a rare event and difficult to diagnose in emergency. We are reporting a case of 14 year old girl who was diagnosed sliding hiatus hernia since childhood but due to delayed treatment presented in emergency with perforation of stomach and generalized peritonitis. She was treated successfully

Massive retroperitoneal mass - giant schawanoma

Schwannoma are usually solitary, slow growing, and non-aggressive neoplasms usually found in head and neck region. Retroperitoneal Schawanoma especially large sized are rare and difficult to diagnose clinically. We are discussing a 43 years old lady, who presented with huge reteroperitoneal mass of left side, treated successfully

Management of congenital club foot

Aims and Objectives: To determine the effectiveness of Ponseti technique with the kite method in the management of congenital club foot

Study Design: It was a prospective interventional study

Place and Duration of Study: The study was conducted in the department of Orthopedic Surgery Foundation University Medical College and Fauji Foundation Hospital Rawalpindi from 1st October 2009 to 31st June 2010

Results: Total of 46 patients with grade 2 deformity was included in the study who meets the inclusion criteria. Patients were randomly divided into two groups of 23 each. Majority of the patients [65%] were between 05-09 weeks of age. The mean age was recorded as 7.7 weeks with S.D of 5.21. TEV is a predominantly male's disease as 65% patients in this study were males, while 35% were females in group-A. Similarly in group-B, males were 78% and 22% were female. Outcome of both the procedures was recorded at three months follow up. In group-A success rate was recorded 74% as compared to group-B in which 87% patients were found in satisfactory range with more than 25 passive range of dorsiflexion at ankle joint

Conclusion: Conservative Ponseti method is the best option for the management of Congenital Talipes Equino Varus [clubfoot] for grade 2 deformity, when starts early. This not only corrects the deformity, preventing surgical intervention but also lessens the financial burden over the parents as well as on the health system

Frequency of ventricular arrhythmias during first 24 hours of acute myocardial infarction in patient thrombolysed with streptokinase

To assess the frequency of ventricular arrhythmias during first 24 hours complicating first episode of Acute Myocardial Infarction in patients thrombolysed with Streptokinase. Cross-sectional, prospective, observational and qualitative study. This study was conducted at Sialkot Medical Complex for six months from March 2010 to August 2010. 200 consecutive patients with acute myocardial infarction who received Streptokinase were assessed for ventricular arrhythmias. Monitoring of the patients for ventricular arrhythmias for 24 hours from the time of admission was done. Arrhythmias from the cardiac monitor's memory noted and documented. Ventricular arrhythmias studied were ventricular fibrillation [VF], sustained ventricular tachycardia, accelerated idioventricular rhythm, non-sustained ventricular tachycardia and premature ventricular beats > 10 beats per hour. Findings were recorded on a specially designed proforma. The data were then entered in the computer for analysis and conclusions were drawn. Reperfusion arrhythmias were observed in 20% of the patients [40/200] in first 24 hours after thrombolytic therapy presenting with first acute myocardial infarction. All the patients included in the study showed the ECG criteria of STEMI and positive quantitatively Troponin T test. Inferior wall MI was the most common type of acute MI. All the patients received IV Streptokinase as thrombolytic agent. The patients with sustained VT [33%] received cardioversion and IV amiodarone. Non-sustained VT were managed by observation only [77%]. A total of 35 patients survived in first 24 hours, five died. Reperfusing arrhythmias are commonly observed in first 24 hours after Streptokinase therapy for acute myocardial infarctions. Most of the non-sustained reperfusion arrhythmias are left untreated and requires observation only but sustained ventricular arrhythmias [VF, VT] can be life-threatening and therefore must be considered for treatment, Electrical cardioversion is preferred over pharmacological treatment in case of sustained ventricular arrhythmias. Survival can be maximized if these arrhythmias are recognized and managed efficiently

Co relation of thyroid function test with the clinical presentation

To correlate the biochemical thyroid profile with the clinical presentation of the patient and decision about the time of surgery. It is an analytical cross sectional study. This study was carried out in the Department of Surgery, Fauji Foundation Hospital, Rawalpindi from 1[st] January 2010 to 31[st] March 2011 Thirty patients were included in this study after taking consent and approval from the ethical committee of the hospital. All of them were females. Age ranges between 13 to 45 with mean of 22.26 years. These patients presented with a swelling in front of neck with or without signs of hypothyroidism or hyperthyroidism. Trial of 6 to 12 months given to every patient to bring the TFT's within normal range. Only those patients were included in the study who took the medicines regularly. Mode of presentation was out door department of Fauji Foundation Hospital Rawalpindi. Patients were examined clinically by surgeon and anesthetist for risk assessment. Routine laboratory investigations including thyroid function test were requested and analyzed by operating surgeon. TFT's were co-related with the clinical signs and symptoms of the patients. Patients were divided into two groups. Group one includes clinically euthyroid patients with TFT's within normal range. Group two again include clinically euthyroid patients but abnormal TFT's. A total of 30 patients were included in this study. All of them were females and clinically euthyroid. Mode of presentation was the outdoor patient department of Fauji Foundation hospital. Presenting complaint was swelling in front of neck. 23 out of 30 patients [66.6%] had normal TFT's and clinically euthyroid. 7 out of 30 Patients [33.3%] shows variation between their thyroid profile and clinical presentation. Sub or near total thyroidectomy was done in all the patients. Recovery was un-eventful. Operation on thyroid gland is a major undertaking and decision should be taken by senior surgeon. Ideally TFT's should be within normal range as well as patient should be euthyroid clinically in order to avoid post operative complications. In those cases where patient is clinically euthyroid but biochemically status is either hyper or hypo thyroid, surgery can be done after clinical trial of at least six months with thyroxin or anti thyroid drugs with a view to bring the TFT's within normal range. We can conclude that although the biochemical profile of the patients with thyroid disease is important but in country like Pakistan where thyroid hormonal assay is not easily available the surgery can be done by careful clinical assessment, keeping in view compliance of patient, regularity of taking medicine, clinical status and side effects of medical treatment

comparison between open and closed hemorrhoidectomy

Haemorrhoidectomy is associated with complications including pain, bleeding and wound infection which can result prolonged hospital stay. Haemorrhoidectomy is considered to provide a better outcome in terms of postoperative pain and wound healing. Aims were to compare postoperative pain, bleeding, operating time and wound healing in patients undergoing open and closed haemorrhoidectomy. This comparative study was conducted in the surgical department at Fauji Foundation Hospital, Rawalpindi from December 13, 2006 to December 31, 2011. Consecutive patients, both male and female, presenting with 3[rd] and 4[th] degree haemorrhoids in the surgical Outpatient Department were included in this study. Half of the patients were assigned to the open haemorrhoidectomy group while the other half was put in the closed haemorrhoidectomy group. Each patient was evaluated by detailed history and examination. Both digital rectal examination [DRE] and proctoscopy were done to confirm the diagnosis. A total of 260 patients were assessed, 130 in each group. In the open group, 52 patients experienced mild pain and 78 moderate while in the closed group, 30 patients experienced mild pain, 87 moderate and 13 patients severe pain. All 130 patients in the closed group showed complete wound healing after 2 weeks as compared to only 66 patients in the open group with a p<0.001. Early and late postoperative bleeding was similar in both groups. The closed technique provides a better outcome in terms of less postoperative bleeding and complete wound healing, but it is associated with more pain