Comparison of silastic and acrylic interpositioning for the treatment of temporomandibular joint ankylosis

The aim of this study was to compare the treatment outcome of thirty unilateral temporomandibular joint [TMJ] ankylosis cases treated in Pakistan Institute of Medical Sciences [PIMS], Islamabad within four years by either silastic or acrylic interpositional arthoplasty. Patients having bilateral TMJ ankylosis, age less than 16 years, coronoidectomy required during procedure, already operated cases and medically compromised patients were excluded from the study. Pre and post-operative assessment was done by thorough history, physical examination and radiographic evaluation [OPG and CT scan] to determine the cause of ankylosis, the maximal inter-incisal opening, complications including infection, presence of facial nerve paralysis and recurrence rate. The maximal inter-incisal opening in the pre-operative period ranged from 0-11mm and was recorded at a mean of 32.7+/-5.8mm for cases treated with silastic interposition and 29.5+/-6.8mm for the ones treated with acrylic one year after surgery. Infections, swelling, pain and nerve injuries were reported in both the groups post-operatively. Both silastic and acrylic were found to be statistically similar in terms of maximal inter-incisal opening, complications and recurrence rates. Recurrence was observed in only one patient treated by acrylic inter-positioning. Silastic however demonstrated itself to be a better choice in terms of handling and patient tolerability

Cerebrospinal fluid rhinorrhea: etiology, site of leakage and endoscopic management

To determine the etiology and site of leak of cerebrospinal fluid [CSF] rhinorrhea and the surgical efficacy of Functional Endoscopic Sinus Surgery [FESS], in closing the defect of CSF leak by different graft materials. Case series. Department of ENT-Head and Neck Surgery, Dow University of Health Sciences, Karachi, from September 2005 to December 2008. Clinical and pathological records of 23 patients who were diagnosed to have cerebrospinal fluid leak and managed by endoscopic approach were studied. Different graft materials alone or in combination were used endoscopically to seal the CSF leak. Results were obtained in terms of successful closure of the CSF leak, as evidenced by cessation of CSF rhinorrhea. Iatrogenic trauma, due to previous surgery, was the commonest cause in [n=9, 39%] patients. Lateral lamella of cribriform plate [fovea ethmoidalis] was the commonest site of leak [n=10, 43.5%]. The leak was closed solely by fat in 15 [65.2%] cases, combination of fat and middle turbinate mucosa [two layered] in 7 [30.4%] patients and temporalis fascia only in one patient [4.3%]. Successful closure of the CSF leak in the first attempt was achieved in 22 [95.6%] patients. Success rate achieved by endoscopic approach in this study was high. However, more data is required to prove the superiority of FESS over intracranial approach for management of CSF rhinorrhea

Comparative analysis of disease activity in patients of chronic hepatitis B virus, with and without super-infection with hepatitis D virus; an experience at tertiary care centre

The hepatitis D virus super-infection contributes significantly to the morbidity and mortality of hepatitis B virus infection. The objectives were to describe the incidence of Hepatitis D virus and comparative analysis of disease activity in patients of chronic hepatitis B virus, with and without super-infection of hepatitis D virus. This Cross-sectional comparative study was conducted at Department of Medicine and Gastroenterology Clinic Jinnah Postgraduate Medical Centre, Karachi, Pakistan from February 2007 to July 2007. HBsAg positive patients who attended our Gastroenterology clinic were selected for the study. After screening for Anti-HDV these patients were segregated in to Anti-HDV positive and negative groups. Data was analyzed on SPSS 12. Eighty-four patients were selected. Seventy-three patients who fulfilled the inclusion criteria were enrolled into the study. Anti-HDV was positive in 23 [31.5%] patients. Among these 23 anti-HDV positive, HDV-RNA was detected in 15 [75%] patients. The differences of age, gender, marital status and area of residence whether rural or urban were not significant between the two groups. HBV-DNA was significantly suppressed in majority of anti-HDV positive patients [p=0.019]. Mean serum ALT levels were significantly higher in patients who had HDV infection [p=0.014]. HDV infection was common in this series of patients with a frequency of 31.5%. All patients of chronic HBV should be screened for HDV whether they are asymptomatic HBV carriers or have chronic active hepatitis particularly when they have raised serum ALT

incidence of foreign bodies and its management in E.N.T. practice

To evaluate foreign body [F.B.] cases in the upper aerodigestive tract and to find out the outcome in their management, in children and adults. On going prospective study. This study was carried out in the department of ENT-Head and Neck Surgery, Lyari Gen. Hospital, Karachi for a period of one year from 1st August 2005 to 31st July, 2006 Patients who visited the Emergency Department or Department of ENT -Head and Neck Surgery, Lyari General Hospital, Karachi, from 1st August 2005 to 31st July, 2006 with a history of F.B. in ear, nose throat, esoghagus or bronchus. Out of 786 patients registered in the study, 652 [83%] were children [age 0-15 years], while 134 [17%] were adults [age above 15 years. The male to female ratio was 1.1:1 The commonest site of impaction of FB was ear in 45.67%, followed by nose. Among children, betel nut was the commonest FB found in 124 [15.77%], followed by rubber pieces in 89 [11.32%], plastic beads in 79 [10.09%], stones in 63 [8%] etc. Coin was found in 38 [4.83%] in the region of cricopharynx and upper oesophagus. The commonest FB among adults was the fish bone in 52 [6.61%], Betel nut is the commonest FB found in children in our region, in this study. 17% of all FB occur in adult age groups. The commonest FB found in adult Age group is fish bone found in 52 patients [6.61% of all FB] Rhinolith was the only FB found in adult noses