Outcome analysis of lateral sphincterotomy in the management of chronic anal fissure

To evaluate the post operative outcome, following lateral sphincterotomy for chronic anal fissure [CAF], in our set up. This prospective study was conducted in the Department of Surgery, Peoples Medical College Nawabshah from July 2005 to September 2009. A total of 80 patients with symptoms of CAF requiring surgery were included in the study having 48 males and 32 females, age ranged between 20-60 years. The diagnosis was made on clinical presentation and confirmed on pen anal examination; lateral sphincterotomy was performed under local or general aesthesia. Patients were followed on weekly bases to see any complication. All the cases of acute and complicated anal fissure were excluded from the study. Anal pain and bleeding. were the leading presentation found in 72 [91%] and 63 [78%] patients respectively, commonest site of fissure was posterior midline in 73 [92%] of cases. Post operative pain was observed in 5 [6%] cases, flatus incontinence in 15 [20%] patients, fecal incontinence in 3 [4%] cases, bleeding in only in 1 [1.2%] patients and infection was observed in 3 [4%] cases. Lateral sphincterotomy is the procedure of choice for the treatment of CAF. It has low rate of incontinence to stool and flatus, low recurrence and healing rate is faster. We advocate this procedure as an ideal treatment for CAF

effect of excessive noise exposure on the hearing thresholds of aviation workers in Karachi

The purposes of this study on Aviation Workers were to [a] determine the prevalence of Noise induced hearing loss [NIHL] in aviation workers [b] suggest measures for its prevention. This cross sectional epidemiological study was conducted with noise exposed and non noise exposed matching variables of adult age group, full time [24 hours], male workers at a large metropolitan airport of Karachi, Pakistan [Noise exposed group], villagers living in the outskirts of Karachi who had their work place and residence within the village [non noise exposed group]. The three measures used were Hearing Questionnaire, Audiological assessment and a record review of base line hearing test [pure tone audiogram] and noise levels at locations of work and residence lived i.e. round the clock noise exposure. Subjects with other causes of hearing impairment like, otitis media, post high grade fever, metabolic disorders and history of ototoxicity were excluded from the study. A significant difference in prevalence of hearing loss [more than 30db] between the noise exposed and non noise exposed group [P<0.5] was noted. Aggressive hearing conservation measures are required for these aviation workers; they are like [a] Availability of HPD's [b] Ban on "Non Certified" aircraft operations as specified by ICAO Chapter 3, Annex-16

Open pyeloplasty in adult patients with primary PUJ obstruction - experience at urology department, Nishtar hospital, Multan

To assess the clinical presentation of primary PUJ obstruction and outcome of pyeloplasty in adult patients. The study was carried out at the Department of Urology, Nishtar Hospital, Multan from June 2006 to June 2007. A total of 25 adult patients were included in the study. All patients were evaluated in terms of clinical presentation, physical examination and investigations. Different techniques of open pyeloplasty were performed in these patients. Out of 25 patients, 16 were male and 9 were females [male to female ratio was 1.8: 1]. Age of patients ranged between 13 to 45 years. All patients underwent some form of open pyeloplasty. Thirteen patients [52%] had Culp Deweerd spiral flap pyeloplasty, 10 [40%] had Anderson Hynes pyeloplasty while 2 [8%] had Foley Y-V pyeloplasty. Minor complications like superficial wound infection [4 patients, UTI [4 patients] and minor anastomotic leakage [1 patients] was seen in early postoperative period. Twenty three [92%] patients had good symptomatic relief, improvement in overall GFR and drainage across PUJ on DTPA seen at 3 months, 6 months and one year follow up. PUJ obstruction is the most common congenital abnormality of ureter, less invasive procedures are available for treatment of PUJ obstruction, but the pyeloplasty is the most effective in relief of obstruction and can be performed safely