ABSTRACT
Objective: To compare fissure healing and complications in chronic anal fissure with use of lateral anal sphicterotomy and 0.2% GTN. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital Rawalpindi and Combined Military Hospital Kohat over a period of 15 months
Material and Methods: Chronic anal fissure was treated with use of lateral anal sphicterotomy after admission to surgical ward and by application of 0.2% glyceryltrinatrate as an outdoor case on 202 patients over a period of 15 months. Sample size was calculated by sample size calculator. Pain was measured using visual analog scale and incontinence to flatus and faeces was inquired from the patients. All cases were called for regular follow up visits but 10 patients failed to report back. Informed written consent was taken from each patient. Inclusion and exclusion criteria were followed. Analysis was done by SPSS version 13 and Chi Square test was applied
Results: Total 202 patients were included in the study and randomly divided into two groups of 101 patients each using random numbers table. Both GTN and sphincterotomy groups revealed significant, but comparable results. Pain relief, fissure healing and incontinence were significantly higher in group B [Lateral anal sphincterotomy] as compared to group A [0.2% GTN]. At the end of 8th week pain relief and incontinence became comparable between both the groups but fissure healing remain significantly higher in group B as compared to group A
Conclusion: GTN when applied to patients produces comparable results if used in long term i.e. eight weeks. It produces adequate symptomatic control and healing of the anal fissures and can be considered equivalent to and one of the recommended treatment options along with lateral anal sphincterotomy in treatment of chronic anal fissure if use for more than 8 weeks. Lateral anal sphincterotomy gives early resolution of symptoms and healing
ABSTRACT
Objective: To evaluate the clinical and demographic characteristics of patients with idiopathic and non-idiopathic vocal cord paralysis [VCP]
Study Design: Descriptive cross sectional study
Place and Duration of Study: Department of ENT Combined Military Hospital Quetta and Rawalpindi, from 10 Dec 2012 to 31 Dec 2015
Material and Methods: The study was a descriptive cross sectional study. The study was conducted after approval by the ethical committee. Patients with fixed vocal cords due to some growth of glottic region were enrolled. All the patients presenting with hoarseness of voice in ENT outpatient department CMH Quetta and Rawalpindi undergoing indirect laryngoscopy and the patients with vocal cord paralysis were selected. Informed written consent was taken and gender, age, name, hospital record number, address and phone number of each individual was noted. Every patient was evaluated by detailed history and thorough clinical examination. Patients were not investigated further if cause were revealed after some investigation. Follow-up of patients was done regularly in ENT OPD. CT scans/US neck was done by radiologist and FNAC/biopsy was reported by histopathologist. Data collected were recorded on proforma
Results: In our study, out of 245 cases, 47.76% [n=117] were 16-40 years old and 52.24% [n=128] were 41-80 years, mean +/- SD was calculated as 41.23 +/- 11.25 years, 45.71% [n=112] male and 54.29% [n=133] were females. Frequency of causes of vocal cord paralysis was recorded as 15.92% [n=39] for idiopathic, 46.53% [n=114] had iatrogenic, 33.06% [n=81] had malignant neoplasm while 4.49% [n=11] had radiation
Conclusion: Vocal cord paralysis is a common clinical condition with substantial morbidity. Awareness on the clinical characteristics and identification of the underlying etiology are keystones for foreseeing complications and determining the required therapeutic modality