Modified quilting sutures: a new technique for hematoma and abscess of nasal septum

This study aimed to analyze the results of a modified continuous quilting sutures technique in a series of patients presenting with hematoma and/or abscess of nasal septum [HANS]. Only patients with a confirmed diagnosis of HANS without co-morbid conditions [which could predispose to a bleeding tendency], were selected. Following incision and drainage, nasal septal flaps were coapted by applying continuous quilting sutures only. The success rate of this technique in terms of recurrence requiring re-exploration and drainage was 100%. Quilting sutures were generally well tolerated with few complaints. Saddle deformity was the most obvious complication of HANS, seen with septal abscess. Quilting sutures can be considered as an alternative treatment option for HANS. The modified technique employed in this study demonstrated impressive results and avoided the morbidity of nasal packing with fewer complications

Comparison of finger glove and ribbon gauze nasal packing after septal surgery

Objective: To compare the efficacy of finger glove and ribbon gauze as nasal packing material after septal surgery by assessing the two parameters of bleeding and pain

Materials and Methods: This cross sectional comparative study was conducted at ENT Department of PNS SHIFA Hospital,Karachi, over a period of one and a half years fromAugust 2014 to January 2016.A total of 100 patients were included in this study. Inclusion criterion was all patients undergoing septal surgery requiring post-operative nasal packing. The right side of nose was packed with finger glove packing and left side of nose was packed with ribbon gauze in every patient. Pain and bleeding were assessed during 24 hour period of packing and on pack removal

Results: Mean blood loss during the packing period and at the time of pack removal was 6.60 ml and 2.31 ml respectively on the finger glove side and 11.40ml and 7.47 ml respectively on the ribbon gauze side [p = 0.001]. Similarly mean pain score on VAS during the packing period and at the time of removal was 2.62 and 3.65 respectively on the finger glove side while 3.37 and 4.41 on the ribbon gauze side[p = 0.001]. No complication from nasal packing was seen on either side

Conclusion: Finger glove is a better choice for packing after septal surgery than ribbon gauze because of less bleeding and pain

Clinicopathological characteristics of nasal polyps with chronic sinusitis

Objective: To evaluate the clinicopathological characteristics of nasal polyps associated with chronic sinusitis in polypectomy specimens

Materials and Methods: A total of 78 cases clinically presenting with signs and symptoms of chronic sinusitis with nasal polyps were studied over a period of 2 years

Results: Out of 78 cases 57 were non-neoplastic and 21 were neoplastic polyps, out of these only two cases were malignant. Non neoplastic polyps were bilateral in 37 cases and unilateral in 30. Majority among non neoplastic category were of inflammatory polyps [53.73%]. Other types included allergic 26.86%, fungal infection with polyp 14.92% and lymphocytic category 4.47%. Majority of the cases that is 93.58%, including all types of polyps presented with nasal obstruction and signs and symptoms of chronic sinusitis

Conclusion: Nasal polyps with chronic sinusitis diagnosed clinically are not always non-neoplastic in nature. Hence, histopathological evaluation in all such cases is essential to diagnose both benign and malignant masses

Frequency of depression among fertile and infertile women

To compare the frequency of depression among fertile and infertile women reporting in CMH Abbottabad. A case control study. This study was conducted in combined military hospital abbottabad, over a period of six months from January 2013 to June 2013. The inclusion criteria were all those patients who were married. All the cases were selected from the women reporting in the obstetrics and gynecology department of CMH Abbottabad for investigation and treatment of infertility. A total of 200 patients, 100 fertile and 100 infertile women were included. Patients were given questionnaire form with their consent for research. Beck depression inventory [BDI] was used to assess depression among fertile and infertile women. Other factors such as age, education level, and duration of infertility, pressure from family members, miscarriages, and support from husband were studied. Depression was significantly higher in infertile women as compared to fertile women i.e. 95% vs. 63% [p<0.001]. It was higher among women with more than 1 year of duration of marriage as compared to those with infertility of one year duration or less. Infertility is associated with depression

Caudal duplication syndrome

Complete duplication of genitourinary system, colon and vertebral column is a very rare and complex congenital condition termed as "caudal duplication syndrome" with variable presentations. This term is often quoted as a type of incomplete separation of mono-ovular twins or conjoined twinning. It is associated with other congenital malformations of the genitourinary, gastrointestinal and other organ systems. The hereby reported case, a 3-month-old male infant had presented with the classical form of the disease i.e., duplication of the gastrointestinal, genitourinary system and vertebral column with anterior abdominal wall hernia and a large lipomeningocele

Intramuscular ceftriaxone as single dose treatment of acute otitis media

To evaluate single dose intramuscular ceftriaxone as an option for the treatment of acute otitis media [AOM]. To compare efficacy of single dose intramuscular ceftriaxone to 10 days treatment with amoxicillin-clavulanate combination. Prospective, randomized, double blind control study. Combined Military Hospital Muzaffarabad, Azad Kashmir, over a period of 02 years from October 2006 to September 2008. A total of 148 freshly diagnosed cases of AOM between ages 03months to 6 years were recruited and divided randomly into two equal groups of 74 each using random numbers table. Group I was administered oral amoxicillin-clavulanate in a dose of 45mg/kg/day in three divided doses along with single intramuscular shot of placebo. Group II was given a single shot of intramuscular ceftriaxone in a dose of 50mg/kg along with placebo syrup thrice a day for 10 days. Patients were reassessed at day 03 and 11. Ninety four point five percent of patients responded to amoxicillin-clavulanate whereas 95.9% responded to single dose IM ceftriaxone. No significant difference was noted between the two types of treatments in term of disease outcome. Single dose intramuscular ceftriaxone can be another option for the treatment of AOM especially in children/parents with poor compliance

Follicular dendritic cell sarcoma of the neck with pulmonary metastases

We present a case of follicular dendritic cell sarcoma in a 48 years old Saudi female who reported with slowly progressive right sided extranodal neck mass associated with pulmonary metastasis. Clinical examination, histopathologic features including distinct immunostains combine together to make the rare diagnosis of follicular dendritic cell sarcoma. This entity is often misdiagnosed due to non-consideration in differential diagnosis of sarcoma. It carries a significant potential for regional as well as distant spread and hence categorized as intermediate risk malignancy. Clinical, histopathological and immunohistochemical aspects and therapeutic options of this unusual case are discussed

Current pattern of mechanical intestinal obstruction in adults

To evaluate the current pattern of mechanical bowel obstruction in adults. Descriptive case series. Surgical unit III and IV Bolan medical college/ complex hospital Quetta, from June 2007 to July 2009. The criteria for diagnosis were on the basis of history, clinical findings, radiological examination, exploration of abdomen and histopathological confirmation in selected cases. A total of 252 surgically treated cases of mechanical bowel obstruction were included. Out of the total, 187 [74.2%] presented with acute and 65 [25.8%] with sub-acute intestinal obstruction. The mean age was 37.4 years with male to female ratio of 2:1. Abdominal tuberculosis was found in 77 [30.6%] patients. Among the other causes bands/adhesions were found in 57 patients [22.6%] and obstructed hernias in 44 patients [17.5%]. In 161 patients [64%] the intestinal obstruction was without gut compromise, while in 91 patients [36% strangulated bowel obstruction was present. Forty patients [15.9%] developed postoperative complications mainly wound sepsis and chest problems in the form of atelectasis and pneumonia. The mortality rate was 2.4% [n 6]

Role of neo-adjuvant chemoradiation in locally advanced rectal cancers

To determine the radiologic downstaging and histological response after neo-adjuvant concurrent chemoradiation in locally advanced rectal cancers. Case series. Radiation Oncology department of Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from December 2004 to November 2005. Thirty patients with histopathologically confirmed locally advanced carcinoma rectum who had not received any treatment [chemotherapy, radiotherapy or surgery] prior to presentation were enrolled. Radiation therapy was delivered with a three-field technique to a dose of 50.4 Gy over 5 weeks at the rate of 1.8 Gy/day. Two cycles of chemotherapy were given synchronously, which comprised of 5-fluorouracil 350 mg/m[2] and folinic acid 20 mg/m[2] continuous intravenous infusion over first five days and last five days of radiotherapy. Surgery was planned 4-6 weeks later to chemoradiation after radiologic post therapy staging. Viable specimens were identified and toxicity was observed. All patients completed treatment without modification. Radiologic downstaging was found in 56.7%, stable disease was seen in 30.0% and progressive disease was present in 13.3% of the patients. Radiologically complete resolution of tumour was not observed. Pathological complete resolution of tumour was achieved in 3.3% and near complete resolution was observed in 13.3% of the patients. In 86.6% cases, a total gross tumour resection with no macroscopic residual disease was possible. All the patients tolerated the treatment well. Neo-adjuvant chemoradiation for locally advanced rectal cancers is associated with high resectability rate and is relatively safe with acceptable morbidity which favours its use in future

Frequency of anxiety in patients reporting for pre-anaesthesia assessment

To study the frequency of anxiety in patients who reported for pre-anaesthesia assessment pre-operatively in Combined Military Hospital [CMH] Malir Cantt and to establish any association of anxiety with demographic characteristics. A cross-sectional study. The study was performed in the Deptts of Psychiatry and Anaesthesiology, CMH, Malir Cantt, from October 2007 to March 2008. One hundred consecutive patients who reported for pre-anaesthesia prior to planned surgeries were included in the study. Inclusion and exclusion criteria were setup. A questionnaire in Urdu language based on Beck Anxiety Inventory was filled up by each patient. Results were summed and statistically analyzed using SPSS 11.0. A total of 100 patients took part in the study ranging from 18 years to 60 years of age. Twenty nine [29%] were males and 71 [71%] were females. Fifty five [55%] were up to 30 years of age and forty five [45%] above 30 years of age. Forty two percent had no anxiety while 58% had varying grades of anxiety; 35% had mild, 17% moderate and 6% had severe anxiety. The frequency of anxiety in males was 48% as compared to 62% in females [P>0.118]. Moreover 40% of patients up to 30 years of age had anxiety as compared to 80% in patients above 30 years of age [P<0.001]. Anxiety was a common problem in patients who were assessed pre-operatively. during pre-anaesthesia. Association of anxiety with gender was insignificant while there was a significant association of anxiety with different age groups

Comparison of efficacy of ciprofloxacin versus gentamicin ear drops in chronic suppurative otitis media [tubo-tympanic type]

To compare the efficacy of ciprofloxacin versus gentamicin ear drops in the treatment of chronic suppurative otitis media [tubo-tympanic type]. Quasi experimental study. This study was conducted in ENT department of Combined Military Hospital Quetta, from 17[th] March 2007 to 16[th] September 2007. Total number of 80 patients were included and divided into two groups of 40 each. Group A received ciprofloxacin ear drops [5 drops, two times in a day] while group B received gentamicin ear drops [5 drops, two times in a day] after aural toilet and than patient called on 3[rd] and 10[th] day of starting treatment for examination and response to treatment observed and documented. Control of ear discharge was significantly better in group A as compared to group B. Efficacy was measured in terms of control of ear discharge and achieving dry ear by comparing both groups on 3[rd], 6[th] and 10 day of starting of treatment. Ciprofloxacin ear drops are significantly better than gentamicin ear drops in controlling ear discharge in chronic suppurative otitis media [CSOM] [tubo-tympanic type]

Dietary supplementations of amino acids: evidence for enhanced serotonergic functions following haloperidol withdrawal in rat medial prefrontal cortex

To investigate the effects of orally supplemented amino acids L-Tryptophan [Trp] and L-Valine [Val] in rats repeatedly injected with haloperidol following one week of drug withdrawal, with particular reference to extrapyramidal symptoms [EPS] and serotonin [5-hydroxytryptamine; 5-HT] metabolism in medial prefrontal cortex [mPFC]. Experimental study. Place and Duration of Study: Department of Biochemistry, University of Karachi from December 2007 to February 2008. The study was conducted on thirty six locally bred male Albino Wistar rats. Freshly prepared amino acids [Val and Trp] were added in the drinking water of rats on alternate days and haloperidol at doses of 5.0 mg/kg or saline were injected twice daily for three weeks following one week of withdrawal. Locomotor/ exploratory activities were scored in activity boxes and open field apparatuses. Catalepsy was monitored on an inclined surface. The animals tested for locomotor activity and catalepsy for two weeks follow-up post-injections plus one week of drug withdrawal were decapitated to collect mPFC regions of rat brain for neurochemical analysis by high performance liquid chromatography with electrochemical detection [HPLC-EC]. There was significant increase [p < 0.01] in locomotor activity in rats orally supplemented with Val and Trp following one week of drug withdrawal from repeated administration. Marked reduction in cataleptogenic effects of the drug was also observed. Significant [p < 0.01] increases in the brain Trp and mPFC 5-HT metabolism in Val and Trp supplemented animals were also noticed. These findings help to demonstrate the effect of dietary amino acids, in particular, Trp to potentiate mPFC serotonergic modulation of neuroleptic activity

clinical study of papular urticaria

To determine the clinical features and demographic profile of the patients having papular urticaria. A case-series. Dermatology Department of Combined Military Hospital, Abbottabad from January to December 2006. Individuals of all age groups and either gender either suspected of or having definite history of insect bite were included in the study. A specially-designed proforma was filled for each patient separately. The proforma included demographic features, information regarding clothing and sleeping habits, personal or family history of atopy and clinical patterns of the lesions. Computer programme SPSS 10 was used to manage and analyze the data. Out of 280 patients, 201 [71.8%] were children upto 12 years of age, 178 [63.6%] were males, 91[32.5%] had atopy, 194 [69.3%] were non-locals, 212 [75.7%] came from urban/pen-urban areas and 173 [61.8%] presented during May-August. Lesions were present over exposed parts of the body in 36 [12.9%], arranged in groups in 152 [54.3%] and were papular urticaria in 185 [66.1%] patients. Children, adult males, non-locals and those belonging to urban/peri-urban areas are more vulnerable to papular urticaria in a particular region. Papular and urticarial lesions arranged in groups over both exposed as well as covered body parts of a single patient is the most common clinical pattern

Pattern of aetiological and predisposing factors regarding carcinoma breast

To study the pattern of aetiological and predisposing factors regarding Carcinoma Breast. Prospective, descriptive study from Jan. 2001 to Jan. 2006. Surgical Unit IV, Civil Hospital, Karachi. All the biopsy proven cases of Carcinoma Breast were included. The relevant data regarding history, risk factors, examination and treatment was recorded and analyzed. The total number Carcinoma Breast cases were 54. Out of these 37[68.5%] were under the age of 50 years and 45[83.3%] belonged to the lower socio-economic group. The mean age at menarche was 13.4 years and at menopause 45.13 years. Nine [16,6%] patients had a positive family history of breast carcinoma or other malignancies, and four [7.4%] patients were nulliparous. None of them had a history of long term use of hormonal therapy i-e oral contraceptives or hormone replacement therapy. The established risk factors like early menarche, late menopause, old age, nulliparity, family history, low socio-economic status differed from the international data. It, therefore, seems worthwhile that a larger scale, multicentric study should be conducted to verify and explain these patterns in our population

Preliminary phytochemical screening of root culture of Tephrosia purpurea [Linn.] lers.

Tephrosia purpurea [Linn.] Pers. is an important Indian medicinal plant. It is used for treatment of liver, kidney and skin disorders, impotency, gonorrhea, rheumatism etc. The present study was carried out to develop and maintain root culture. This is the first report on the root culture of this medicinal plant. The qualitative chemical tests on extracts of natural roots and the roots developed in cultures showed the presence of alkaloids, flavonoids, saponins, steroids, proteins, amino acids and reducing sugars while anthraquinones were absent in both the samples

Management of symptomatic Meckel's diverticulum

The objective of this study was to evaluate the management of symptomatic Meckel's diverticulum. This study was conducted between November, 1999 to November, 2001 at three surgical and one pediatric surgical unit in Sandeman [Prov] Hospital Quetta.A total of 1995 patients were operated with provisional diagnosis of acute abdomen out of which 20 cases were of Meckel's diverticulum. In most of the patients resection of Meckel's diverticulum or resection of gut with Meckel's diverticulum was done and anastomosis performed. The mean age was 16.05 years with male: female ratio 9:1. Abdominal pain was the most common symptom [75%]. Operative findings were volvulus around a band between Meckel's diverticulm and umbilicus in four [20%], omphalodiverticular fibrous band causing kinking of the adjacent gut in two [10%], ileocolic intussusception due to Meckel's diverticulum in two [10%], volvulus around a band with gangrene of gut in two [10%], mesodiverticular band entrapping a small bowel loop in one [5%], inflamed perforated Meckel's diverticulum causing peritonitis and intestinal obstruction in one each [5%], inflamed thick edematous Meckel's diverticulum in six [30%], patent vitellointestinal duct with Meckel's diverticulum in one [5%] and bleeding Meckel's diverticulum in one [5%]. The patients who presented with acute abdomen, no preoperative diagnosis regarding involvement of diseased Meckel's diverticulum can be reached with most of the available modalities of investigation in this region. In children presenting with acute abdomen Meckel's diverticulum must be kept in mind