Outcome of the limberg's flap technique in the treatment of pilonidal sinus

Background: Pilonidal sinus disease is a common condition often seen in young adults, affecting male twice then the female. Many surgical and non- surgical treatment modalities have been suggested

Objective: To evaluate the results of rhomboid excision and Limberg flap reconstruction in the treatment of pilonidal sinus disease

Methodology: This cross-sectional study was carried out at Surgical Department Unit-II Sheikh Zayed Medical College and Hospital, Rahim Yar khan. The study was conducted from 1 June 2014 to 31 January 2016. A total of 34 patients were included in this study. Patients having primary pilonidal sinus disease underwent this operation. Data analysis was carried out by using SPSS Version16 software

Results: 34 patients has undergone this surgery. All study subjects were males. The mean age was 26 years [Range: 18-36 years]. No patient presented with recurrent pilonidal sinus. The mean operative time was 55 minutes and ranged from 45 to 65 minutes. Hospital stay ranged from 3 to 4 days. Two [5.88%] patients has minimal epidermolysis of flap corners. Two [5.88%] has slight gaping of wound edges. However all four healed completely with conservative treatment. One patient has persistent discharge which took 3 weeks to settle down. 100% success rates with no recurrence was achieved

Conclusion: Limberg flap technique is very effective for pilonidal sinus disease with low complication and excellent success rates

Histomorphological features of placentae in pregnancies complicated with intrauterine growth restriction

Fetal growth retardation is most commonly caused by placental letdown to meet the increasing demand for oxygen and nutrients of the developing fetus. Intrauterine growth restriction [IUGR] is common happening in Pakistani setup especially in rural areas. Current literature suggests that placental causes are more common than the maternal causes in intrauterine growth restriction. Macroscopic and microscopic examination of placenta can help us to identify the patho-physiology of placental involvement. This is reasonable especially in those cases of intrauterine growth retardation which are not perplexed by maternal causes. To identify macroscopic and microscopic features of placenta in pregnancy complicated with IUGR. Descriptive study. This study was conducted at Sheikh Zayed Medical College/Hospital, Rahim Yar Khan in collaboration with Department of Pathology Quaid-e-Azam Medical College, Bahawalpur and Anatomy Department, Nishtar Medical College, Multan. Study duration was two years from July, 2010 to June, 2012. One hundred and fifty placentae, 85 from cases of intrauterine growth retardation and 65 from normal [control] were enrolled for the study. Fetal and placental weights and placental diameter and thickness were measured. Tissue for histological examination was obtained from: i] Umbilical cord ii] membranes and iii] three placental zones. The tissues were processed and stained with Haematoxlyin, Eosin and Mallory's Trichrome. The prepared tissues were studied microscopically for villous and intervillous lesions utilizing various criteria. Macroscopically there was significant decrease in placental weight, fetal weight, and placental diameter and thickness. Microscopic findings were increased fibrinoid necrosis [46.7%], increased perivillous fibrinoid deposition [16.7%], increased syncytial knots [60%] and increased placental infarction [1.8%]. These findings document comparatively higher frequency of fibrinoid necrosis and perivillous fibrinoid deposition. This draws ours attention to the predominant role of placental causes in cases of idiopathic intrauterine growth retardation

Anatomy resource centre

It has been seen that just delivering the lectures of anatomy followed by dissection may fail to produce a long lasting understanding of the subject. The students are also unable to appreciate the importance of clinical anatomy integrated within various medical disciplines. A medical college or university may look at restructuring the medical curriculum with an anatomy resource centre which can have a pivotal influence on self-directed learning. [1] To prepare an innovative resource centre for teachers. [2]. To rain student to achieve sufficient knowledge, skill and attitude when given a problem-solving exercise. The resource centre is equipped with routine cadaveric dissection. Such gross structural relationships are made more meaningful by the use of living anatomy such as conventional radiographs, CT, MRI, ultrasound, laparoscopic, videos and surface anatomy. Simultaneous presence of microscopic anatomy [histology] can help to understand cell biology and molecular medicine in great detail. It is also necessary to use plastic models to overcome the complexity of the structures such as perineum and joints. Web-based computer sites can supplement the effort and to achieve what is called 'self-directed assessment skill'. Once the students are aware of the normal structures, they can be challenged with abnormal structures or tissues. An anatomy resource centre thus, can be integrated with various disciplines. However, it is felt that an efficient clinical anatomy curriculum can only lead to the success in developing an innovative anatomy resource centre for teachers and students

Incidence of thyroid IMA artery in our population

To find out the incidence of thyroid ima artery in our population. An exploratory study. This study was conducted in a private hospital and Nishtar Hospital Multan. Study was conducted from 15 Jan to 25 September 2012. All the patients with the goiter and who were euthyroid presenting to the Nishatr Hospital and private hospital [Khursheed Rafiq Hospital] in Multan were included in study.Patients with tumors and huge retrostemal goiter were excluded from the study.During surgery of thyroid, meticulous dissection was done to identify the thyroid ima artery and incidence was recorded. A total no of 87 patients were included in the study. Out these 7 were excluded due to the huge goiter with difficult surgery. Out of remaining 80 pts, 65 [80%] were females on 15 [20%] were females, [ratio of female to male 4.3: l].The mean age of the patients was 45 years [from 70 years to 20 years] The thyroid ima artery was found in 4 pts only [5%].All the patients were females It means that incidence of this artery in females is more than males.It may be due to the more incidence of goiter in females [80%] than males as this study was conducted only patients suffering from goiter. In both patients this artery was supplying the isthmus of the thyroid gland. This was of adequate size. Inferior thyroid artery was also present in both cases. The incidence of thyroid ima artery was recorded to be 4% in our population

Frequency of congenital anomalies in Southern Punjab

To determine the pattern of major congenital malformations in neonates admitted in Nishtar Hospital Multan and evaluate their early outcome. Descriptive study. This study was conducted at the Department of Anatomy, in collaboration with department of Gynaecology and Obstetrics and department of Paediatrics Nishtar Medical Institution Multan from March to August 2012. A total of 431 neonates were admitted in Paediatric Wards including those referred from outside and from Labour Room of Nishtar Hospital. Children with major congenital malformations were identified by clinical examination and confirmed by appropriate radio-diagnostic methods. These neonates were immediately referred to the surgical team for intervention. A total of 57 neonates with congenital malformations were admitted during the study period. Thirty one were males and, 26 females. Fetal anomalies were diagnosed correctly in 17 cases out of a total of 19 inborn deliveries on maternal ultrasound while it was missed in one fetus and incorrectly diagnosed in one case. A total of 48 patients had surgery out of which 4 [8.3%] died in the neonatal period. Five cases were booked for elective surgery beyond the neonatal period. Out of 4 neonates with congenital heart disease one case was referred outside, one neonate died preoperatively while 2 infants were managed conservatively. Due to detection of fetal anomalies, early surgical intervention, and intensive neonatal care, most infants can be rescued after a successful primary operation

Correlation of triceps skin fold with BMI in age matched men: anthropometric analysis

To study the thickness of the triceps subcutaneous fat measured by the caliper anthropometry, in age matched individuals having different body mass indices; and to determine if there is any correlation between the thickness of subcutaneous fat with that of the body mass index [BMI]. Cohort prospective. This study was conducted at Anatomy Dept, Nishtar Medical College, Multan from August 2010 to December 2010. Observations were made on 260 healthy men of 20-50 years of age. Regression analysis and Pearson's correlation coefficient were computed and are statistically significant [p < 0.05-0.01]. The results reveal that the triceps skin fold fat was very strongly correlated [range = 0.88 to 0.96] in all age groups. While in case of BMI it good in Groups I and II. On the other hand Age and BMI show little correlation with that of triceps muscle area. The results are statistically significant p value being 0.05 to .01. The study reflects some limitations of triceps anthropometry in estimating obesity but still has value in assessing nutritional status in special circumstances like refugee camps, schools

Role of F.N.A.C USG and scintigraphy in the evaluation of solitary thyroid nodule

Diseases of thyroid gland are perhaps the commonest endocrine disorders. Solitary thyroid nodule is a common clinical entity encountered. So its evaluation by different investigation is very important. Purpose of study was to find out the most appropriate investigation in the evaluation of solitary thyroid nodules. Surgical unit, Nishtar Hospital, Multan. Two years, from March 2002- March 2004. Fifty patients. In this study, it was found that the sensitivity and specificity of Fine needle aspiration cytology to malignancy was 80% and 93.3% respectively. So it was concluded that Fine needle aspiration cytology was the most sensitive and specific investigation in evaluation of solitary thyroid nodule to differentiate between benign and malignant nodules. It was found to be extremely safe, in expensive and relatively accurate in the evaluation of solitary thyroid nodule. In this study, it was found that thyroid ultrasound couldn't differentiate benign from malignant nodules. Thyroid scan had excellent sensitivity but very low specificity. But it couldn't differentiate benign from malignant nodules

Comparative study of fistulectomy vs fistulotomy in treatment of fistula-in-ano regarding postoperative complications and long term results

Fistula is defined as chronic granulating tract connecting two epithelial lined surfaces. These surfaces may be cutaneous or mucosal. An anal fistula is a track with an internal opening in the mucosa of the anal canal or retctum. To compare fistulectomy vs fistulotomy regarding postoperative complications and long term results. All patients having fistula-in-ano of low variety were treated with to procedures, fistulectomy and fistulotomy. These patients were divided into two groups. In one group fistulectomy was done and in other group fistulotomy was done. Out of patients operated for perianal fistula of low variety, 60 were males and 20 were females. The male to female ratio was 3:1. The patients of perianal fistula present with different symptoms. Patients present with discharge were 28, with pain and perianal abscess were 38 and with perianal itching were 14. The patients of perianal fistula belong to the different categories, the 50 belong to poor group, 20 belong to middle class and 10 belong to rich group. In this study, 40 patients were operated by fistulotomy, pain was present in I patient. In another 40 patients who were operated by fistulectomy pain was present in 2 patients. It has been concluded that complete removal of fistulous tract and minimal postoperative complications are the keys to be success in fistula surgery

Closed versus open lateral internal sphincterotomy in chronic anal fissure: a comparative study of postoperative complications and results

In present study, patients of anal fissure admitted to surgical units of Nishtar Hospital, Multan were treated by lateral internal sphincterotomy by open and closed methods. The patients were followed up for a period of 6 months after surgery. The results of treatment were evaluated with reference to postoperative complications. Out of the 100 patients included in the study, 50 patients underwent open lateral internal sphincterotomy and the other 50 were subjected to closed lateral internal sphincterotomy. There was no significant difference in postoperative acute complications. However, incontinence in terms of soiling and passage of flatus was 30% in open method and 20% in closed method. There was no difference in terms of recurrence rate being 10% both in open and closed methods. Hospital stay was less in closed method. Healing rate was nearly equal in both procedures. Keeping in view these findings, it is recommended that chronic fissure should be treated by closed method, if the surgeon is experienced