Local infilteration of steroid in conjunction with coccygel manipulation as a treatment of coccydynia

To asses the efficacy of local infiltration of steroid in conjunction with coccygel manipulation as a treatment of coccydynia. Interventional study. Department of Orthopaedic Surgery, Ziauddin Hospital Karachi, from December 2000 to December 2008. All selected patients who did not improve three to six month of conservative treatment, were enrolled. The patients were treated with local infiltration of steroid in conjuncation with coccygel manipulation and followed for up to 2 years. A total of 172 patients were diagnosed with coccydynia. The average age of the patients was 38.3 year. There were 138 [80.2%] males and 34 [19.8%] females. Trauma was responsible for pain in 118 [68.6%] cases. Of the total patients, 97 [56.4%] recovered with conservative management and remaining 75 [43.6%] underwent manipulation of coccyx under sedation with local infiltration of steroid. Fifty three [70.7%] patients had excellent results, 14[18.7%] had good response and 8 [10.7%] had fair outcome on first visit. In 2 year follow up 60 [80%] patients showed good response. Second injection was given in 5[6.7%] patients and 3[rd] injection was needed in one [1.3%] patient. Nine [12%] patients were lost to follow up. We recommend manipulation along with local infiltration of steroid in all patients of coccydynia. This approach is less invasive and carried out under sedation as a daycare procedure.

Serum hyaluronic acid as a marker of hepatic fibrosis

To determine the serum hyaluronic acid [HA] levels as biochemical marker of hepatic fibrosis and cirrhosis and correlate it with the degree of hepatic fibrosis and cirrhosis. Comparative cross-sectional study. The Armed Forces Institute of Pathology, Rawalpindi from September 2003 to August 2004. This study was performed on 100 patients of chronic liver disease whose liver biopsies had been carried out. Fifty healthy controls were also included in the study. Routine liver function tests, hepatitis serology and serum hyaluronic acid levels were carried out on patients and controls. Liver biopsy of 100 patients revealed that 21 were in stage 0 fibrosis, 38 in stage 1 fibrosis, 26 in stage 3 fibrosis and 15 in stage 4 fibrosis. Mean Serum HA [mean +/- SD] concentration in patients were 189 +/- 98 micro g/L vs. 21 +/- 10 micro g/L of healthy controls. The difference observed was statistically significant [p < 0.001]. Patients in stage 4 fibrosis had significantly higher [p <0.001] mean serum HA concentration as compared to other stages of liver fibrosis. Diagnostic accuracy of serum HA at marginally elevated level of 60 micro g/L determined the sensitivity 78.4%, specificity 80.9%, positive predicted value 93.9% and negative predicted value of 50%. Serum HA is a useful non-invasive marker of liver fibrosis. There is a strong positive correlation between serum HA levels and degree of liver fibrosis. The concentration of serum HA rises according to progression of liver fibrosis and levels are highest in patients with liver cirrhosis

Outcome of total knee replacement in 232 cases

To evaluate, clinically and radiologically, the outcome of total knee replacement [TKR] in our institute. Design and Descriptive, prospective study conducted from Jan. 1999 to Dec. 2003.Ziauddin Medical University Hospital, Karachi.All patients who underwent TKR at our institute.: All patients who underwent TKR were evaluated clinically and radiologically on the basis of modified INSALL knee scoring system prior to surgery and postoperatively between one to three years after surgery. Pre and post operative scores were then compared for each patient to find improvement, both functional and radiological. Amongst the 232 patients that were included in the study, there were 83 males and 149 females, with ages ranging from 58 to 80 years. The preoperative INSALL Knee Scores were between zero to 30 for 87% of patients. Postoperatively 90% of patients had scores greater than 90 and most of them achieved 120 degrees of flexion.Total knee replacement is an excellent modality of treatment for patients suffering from severe arthritis of knee joints with regards to pain, range of motion and stability

Pattern of serum protein electrophoresis in various diseases

To determine the frequency and pattern of different clinical disorders on the basis of serum protein electrophoresis [SPE]. Descriptive cross sectional study. The study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, during May 2003. Five hundred SPE strips [spanning over a period of one year] of patients along-with relevant clinical information were analysed to determine the frequency and pattern of clinical disorders. Out of the 500 strips analyzed, 324 were from males [mean age: 53.5y] and 176 were from females [mean age 51.5 y]. Six major patterns were found including chronic inflammation [40.4%], acute phase response [20.8%], nephrotic syndrome [6.8%], paraproteinemia [9.2%], hepatic cirrhosis [0.8%] and normal pattern [21.18%]. Chronic inflammatory disease was found to be the most frequently observed pattern