Treatment of shoulder dislocation with greater tuberosity and glenoid fractures

Large glenoid fractures are relatively uncommon with shoulder dislocation. Simultaneous glenoid and greater tuberosity fractures with anterior shoulder dislocation are very rare. We report on a 48-year right-handed male who sustained a fall during skiing. He had anterior shoulder dislocation combined with large glenoid fracture and greater tuberosity fracture. He was treated surgically with fixation of the glenoid and greater tuberosity fractures, using two different approaches. The deltopectoral approach with coracoid osteotomy and subscapularis split was used for glenoid fixation. McKenzie's approach was used for greater tuberosity fixation

Delta Reverse Polarity Shoulder Replacement: Single Surgeon Experience with a Minimum 2-Year Follow-up

BACKGROUND: The delta reverse shoulder replacement system was developed for the treatment of rotator cuff arthropathy so that the deltoid can substitute for the deficient rotator cuff. To evaluate the results of delta reverse shoulder replacement for functional improvement and complications in a consecutive series by a single surgeon over a period of six years with a minimum follow-up of 2 years. METHODS: The data were collected retrospectively from electronic theatre records. Over a period of 6 years (2006-2012), 46 cases that fulfilled the inclusion criteria were identified. There were 34 females and 12 males. The average age of patients was 76.2 years (range, 58 to 87 years). A single surgeon performed all procedures using the anterosuperior approach. The mean follow-up time was 49 months (range, 24 to 91 months). All cases had preoperative and postoperative Constant scores. We collected the data on indications, hospital stay, and change in the Constant score, complications, and reoperation rates. RESULTS: The main indication for surgery was rotator cuff arthropathy (52.2%), followed by massive rotator cuff tear (28.3%), osteoarthritis (8.7%), fractures (6.5%), and rheumatoid arthritis (4.3%). Also, 65.2% of the cases were referred by general practitioners, 26% of the cases were referred by other consultants, and 8.8% of the cases were already under the care of a shoulder surgeon. The average preoperative Constant score was 23.5 (range, 8 to 59). The average Constant score at the final follow-up was 56 (range, 22 to 83). On average, there was an improvement of 33 points in the Constant score. The improvement in the Constant score was significant (p < 0.001). We observed complications in four patients (8.6%). Three of four patients (6.5%) needed reoperation. The first complication was pulmonary embolism in the early postoperative period. The other complications included dissociation of the glenosphere from the metaglene, deltoid detachment, and stitch abscess. CONCLUSIONS: This is a single-surgeon, single-approach series of 46 cases with a minimum follow-up of 2 years. At this stage, the results are encouraging with no cases of loosening, dislocation, or nerve injury.

Cytomorphology versus conventional microbiological tests in the diagnosis of tuberculous lymphadenitis

To determine the accuracy of Fine Needle Aspiration Cytology [FNAC] in the diagnosis of tuberculous lymphadenitis. Comparative cross-sectional study. Department of Pathology, Khalifa Gul Nawaz Teaching Hospital [KGNTH], Bannu, from September 2012 to March 2013. FNAC of enlarged lymph nodes was performed in the Department of Pathology, KGNTH, Bannu. Smears of the aspirates were examined under light microscope after staining with Haematoxylin and Eosin [H and E] stains. In cases of chronic lymphadenitis, the smears were stained with Ziehl-Neelsen [ZN] stain for Acid Fast Bacilli [AFB]. If no AFB was visualized, the aspirate was subjected to culture on Lowenstein Jensen [LJ] medium for yield of AFB. The results were analyzed by Microsoft Excel software. Chronic granulomatous lymphadenitis was found in 110 [46.81%] out of 235 cases. AFB were seen in aspirates of 43/110 [39.09%] cases by direct microscopy. Among the remaining 67 aspirates subjected to LJ medium, only 07 [10.45%] yielded growth of AFB. Smears of 4/15 [3.6%], 13/47 [11.7%] and 33/48 [29.7%] cases with haemorrhagic, inflammatory and caseous background respectively, were confirmed by conventional microbiologic tests. Out of 125 nongranulomatous lymphadenitis cases only 05 were confirmed to be due to tuberculosis by direct microscopy while culture was not positive in any case. Thus accuracy of FNAC was 72.34%.FNAC has a good accuracy in diagnosing tuberculous lymphadenopathy

Management of Proximal Phalangeal Fractures of the Hand Using Finger Nail Traction and a Digital Splint: A Prospective Study of 43 Cases

BACKGROUND: Proximal phalangeal fractures are common fractures of the hand. The fractures are difficult to treat because of vicinity of two important joints and crossing long tendons. The purpose of this study was to evaluate the efficacy of nail traction technique in the management of proximal phalangeal fractures of the hand. METHODS: Patients (n=43) with proximal phalangeal fractures were treated by nail traction and evaluated prospectively. We assessed all the patients at the time of presentation and then followed a standard protocol for recruiting patients. After application of nail traction, the patients were initially assessed at 12th day. The outcome measures included post reduction radiographic evaluation and total active motion (TAM) in finger at the final follow-up appointment. All the patients were followed for one year. RESULTS: The post-reduction X-ray evaluation showed good reduction in 33 cases, fair reduction in 8 and poor reduction in 2 cases. At final assessment, 35 patients had good TAM score, six had fair and two had poor TAM score. Complications were noted in two patients and these included pressure necrosis in palm and stiffness in proximal interphalangeal joint. CONCLUSIONS: The results of this prospective study show that with careful selection of patients, nail traction seems to be simple, safe and effective technique for managing proximal phalangeal fractures.

Combining ability study in a 6x6 diallel cross of maize

The F[1] generation of 6x6 diallel cross in maize was evaluated for combining ability under irrigated conditions of Dera Ismial Khan, Pakistan. Based on the variance data, general combining ability [GCA] and specific combining ability [SCA] showed the importance of additive gene effect in some characters under study like kernel rows/ear, kernels/ear, 1000 grain weight and grain yield. The results showed that F[1] mean squares due to GCA were highly significant for all the parameters under observation. Higher magnitude of GCA components of variance [%] for kernels/ear, 1000 grain weight and grain yield, indicated predominance of additive and additive type of gene action while for kernel rows/ear, and kernels/row, nearly equal importance of both additive and non-additive gene effects were observed. The estimates of GCA effects revealed that parents Jalal and Sarhad White were good general combiners for most of the traits under discussion. The crosses, Kisan x Azam and Azam x Sadaf showed good SCA effects with excellent mean performance for most of the traits studied in F[1]

Common trend of antibiotics usage in a tertiary care hospital of Peshawar, Pakistan

Antibiotics are used to eradicate the pre- and postoperative infections in surgical procedures and in all others medical cases. However, inappropriate and indiscriminate use of antimicrobial agents can potentially have a number of problems. The emergence of antimicrobial resistant bacteria, an increased number of patients experiencing adverse drug events, and increased drug-related cost have been documented. The objective of the study was to determine the trend of use of antibiotics and hospitalisation of patients in various units of a tertiary care hospital, to investigate practice variation of antimicrobial agents within the hospital, and to identify and document any opportunity for its improvement. A questionnaire containing relevant information about the study was prepared. Patients' age, sex, diagnosis, duration of hospital stay and type of antibiotic used were recorded and analysed, with particular reference to antibiotic group and disease pattern, in 3 different treatment areas of Hayatabad Medical Complex [HMC], Peshawar, Pakistan, from July 2006 to June 2007. During the period under report, a total of 519 patients were studied for their disease and the type of antibiotics used. The leading type of antibiotics reported were 3rd generation antibiotic used on 147 [28.33%] patients in the 3 units collectively, 1[st] generation 127 [24.47%], and penicillin 99 [19.08%], while macrolides were the least used. The available resources are needed to be effectively utilised, to minimise the hospital stay due to rational use of antibiotics, and to minimise burden of antibiotics on poor patients

Relationship between sialic acid and microvascular complications in type 2 diabetes mellitus

Serum total sialic acid is a marker of acute phase response. Elevated levels have also been associated with several risk factors for diabetic vascular disease

Objective: to study relationship between sialic acid and metabolic variables in type 2 diabetic patients with and without microvascular complications

Material and Methods: this study included 200 subjects of which 50 were of diabetes mellitus with nephropathy 50 patients of type 2 diabetes mellitus with retinopathy50 patients of type 2 diabetes without any complication and 50 healthy individuals without diabetes mellitus. [Control subjects]. Tl1e subjects aged 15-60 years were selected for study. Fasting venous blood samples were taken from all these 200 subjects. Simultaneously urine sample were also collected from each of them. All blood samples were analyzed for fasting and postprandial glucose, total cholesterol triglyceride [TG], low .density lipoprotein [LDL], high density lipoprotein [HDL], creatinine, HbAlc on fully automated analyzer. Serum and urine sialic acid along with micro albumin levels were also estimated

Results: serum total sialic acid concentrations were significantly higher among all diabetic subjects with or without complications compared to control subjects. In diabetics patients there was a significantly increasing trend of serum and urinary sialic acid with severity of nephropathy [P<0.001] and with degree of urinary albumin excretion [p<0.001]. Elevated serum sialic acid concentrations were also associated with several risk factors for diabetic vascular disease: diabetes duration HbAlc, serum triglyceride, serum cholesterol, and HDL and LDL concentrations. Significant correlations were found between sialic acid concentrations and cardiovascular risk factors like LDL and TG in diabetic patients

Conclusion: the main finding of this study is that elevated serum and urinary sialic acid and micro albumin concentration were strongly related to the presence of microvascular complications like diabetic nephropathy and retinopathy and cardiovascular risk factors in type 2 diabetes patients

Transanal small bowel evisceration following digital reduction of a chronically prolapsing rectum

Evisceration of the small bowel through a rectal perforation is rare. This is the case of a 66 year-old female presenting to the Accident and Emergency Department with transanal evisceration of her small bowel resulting from attempted digital reduction and subsequent tear of her chronically prolapsing rectum. Reduction of the prolapsed small bowel and primary repair of the rectal tear were carried out at laparotomy. The management of this case is discussed

Vitamin E and C status in hemodialysis pateints of Shaikh Zayed hospital [Lahore]

Cardiovascular disease is the major cause of mortality in patients receiving haemodialysis for chronic renal failure. Increased lipid peroxidation and deplation of antioxidants may contribute to increased risk of atherosclerosis. The present study was carried out to see the predialysis level of vitamin C and vitamin E in ESRD [end stage renal disease] patients of Shaikh Zayed Hospital Lahore receiving regular heamodialysis, and also the immediate effect of dialysis on vitamin C and E levels. Fifty ESRD patients on heamodialysis and 15 healthy control subjects matched for age and sex were included in the study. Forty one patients and 12 controls were in the age range of more than 30 years. No significant difference was seen in the predialysis vitamin C level of patient and control, but the fall after dialysis was significant. No significant correlation could be elicited between the post dialysis fall of vitamin C level of 6 or more than 6 mg/l in patient with previous history of diabetes/hypertention, period of dialysis or frequency of dialysis. Predialysis vitamin E level of patient was significantly lower than control subjects, where as the level of vitamin e was lower in female than male patients. no significant fall of vitamin E level was seen after dialysis. No significance could be elicited between initial lower level of vitamin E, [less than 6 mg/l] and previous history of diabetes/hypertention, period of dialysis and frequency of dialysis