Outcome of stapled haemorrhoidectomy versus open milligan morgan haemorrhoidectomy at allied hospital

Objective: to compare the postoperative outcome of stapled haemorrhoidectomy and conventional Milligan Morgan's haemorrhoidectomy at Allied Hospital

Study Design: simple comparative study

Place of Study: Surgical Unit 1, Allied Hospital Faisalabad

Duration of Study: January 2011 to September 2012

Sample size: 50 patients

Material and Methods: fifty patients of 3rd and 4th degree hemorrhoids were selected for admission from the outpatient department. Patients with additional anal disease [e.g. fissure, abscess, fistula, ano-rectal cancer etc.] were excluded. Two groups of twenty five each were made. Group A for stapled haemorrhoidectomy and Group B for Milligan- Morgan haemorrhoidectomy [MMH]. The operative time was measured in minutes. Postoperative pain was assessed through visual analogue scale [VAS]. Bleeding was measured as mild, moderate and profuse. Other postoperative complications during hospital stay like urinary retention, anal stenosis etc. were noted. T-test, chi-square test and repeated measured analysis of variance were applied to compare the variables

Results: a majority of patients[combined in both groups] had third degree haemorrhoids. The mean length of operative time was found statistically insignificant between stapled and open groups [34 vs 36 minutes]. In Group A 23 [92%] patients were discharged in 24 hrs while 2 [8%] patients were discharged after 24 hrs. In Group B 9 [36%] patients were discharged in 24 hrs and 16 [64%] patients were discharged after 24 hrs. In group A 19 [76%] patients were having mild bleeding, 5 [20%] moderate bleeding and 1 [4%] profuse bleeding. In Group B 7 [28%] patients were having mild, 16 [64%] moderate and 2 [8%] profuse bleeding. In Group A 15 [60%] patients were having mild pain, 7 [28%] moderate and 3 [12%] severe pain on visual analogue scale. In Group B 4 [16%] patients were having mild pain, 15 [60%] moderate and 6 [24%] severe pain. The proportion of postoperative anal stenosis, prolapsed recurrence, persistent pain, recurrent bleeding and urinary retention was higher in MMH than stapled haemorrhoidectomy group

Conclusion: there was a significant difference between stapled haemorrhoidectomy and Milligan Morgan's for bleeding, pain and hospital stay. However the mean length of operative time was insignificantly different

Congenital complete absence of pericardium masquerading as pulmonary embolism

Congenital absence of the pericardium is a rare cardiac condition, which can be either isolated or associated with other cardiac and extracardiac anomalies. There are six different types, depending on the severity of the involvement. Most of the patients with this defect are asymptomatic, especially the ones with complete absence of the pericardium. However, some patients are symptomatic, reporting symptoms that include chest pain, palpitations, dyspnea, and syncope. Diagnosis is established by the characteristic features on chest X-ray, echocardiogram, chest computed tomography [CT], and/or cardiac magnetic resonance imging [MRI]. We present here a case of a 23 year-old-male, who presented to our hospital with complaints of pleuritic chest pain and exertional dyspnea, of a two-week duration. He was physically active and his past history was otherwise insignificant. His chest CT with contrast was interpreted as showing evidence of multiple emboli, predominantly in the left lung, and he was started on a heparin and warfarin therapy. A repeat chest CT with contrast three weeks later showed no significant change from the previous CT scan. Both scans showed that the heart was abnormally rotated to the left side of the chest. An echocardiogram raised the suspicion of congenital absence of the pericardium, with a posteriorly displaced heart. In retrospect, motion artifact on the left lung, attributed to cardiac pulsations and the lack of pericardium, resulted in a CT chest appearance, mimicking findings of pulmonary embolism. The misdiagnosis of pulmonary embolism was attributed to the artifact caused by excessive cardiac motion artifact on the chest CT scan. In non-gated CT angiograms, excessive motion causes an artifact that blurs the pulmonary vessels, reminiscent of a 'seagull' or a 'boomerang'. Physicians need to be aware of this phenomenon, as well as the characteristic radiological features of this congenital anomaly, to enable them to make a correct diagnosis

Patterns of refractive errors at independent medical college, teaching hospital, Faisalabad

To determine the patterns [Frequency and types] of refractive errors, affecting different age groups of our population and to suggest glasses for huge functional improvement of individuals. Descriptive Study. This conducted at Independent University Hospital Faisalabad in collaboration with Allied Hospital [Punjab Medical College] Faisalabad from 15 March 2010 to 31 March 2011. Patients of all age groups presented in Eye OPD with the complaint of visual acuity having less than 6/12, were underwent history and detailed examination [Including retinoscopy, autorefraction and cycloplegic refraction in children less than 8 years]. Patients with corneal opacity, glaucoma, penetrating trauma, cataract,aphakia, macular or retinal diseases were excluded. Out of 8215 OPD patients 658 [8%] had refractive error. Mean age was 31 years. Age varied from 5 to 66 years. New patients were 533[81%], while patients required refinement of refraction, were 125 [19%]. Individuals up to the age of 15 years were 119 [18.08%], between 16 to 29 years were 196 [29.79%], 30 to 40 years were 151 [22.95%] and above 40 years were 192 [29.17%]. It was found that male were 260 [39.51%] while female 398 [60.49%]. Myopia was 381 [57.90%] hypermetropia was 122 [18.54%] while astigmatism was 155 [23.56%]. Myopic astigmatism was 114 [17.33%] and hyperopic ttendance was 41 [6.23%].All individuals showed improvement with glasses. Refractive error is very common in our population. Female are affected'more commonly than males. Myopia is more frequent. Astigmatism also affects almost every fifth patient with refractive error

Syringing and probing results for congenital nasolacrimal duct obstruction

The study was conducted to study the results of syringing and probing technique for treatment of congenital nasolacrimal duct obstruction from the data collection, recorded at Eye Operation Theater and clinics for the patients treated by the said technique. Retrospective Cross-sectional study technique was used. From January 2003 to December 2005. In the study 90 respondents were included with age from six months to five years of both sexes, observed at DHQ Hospital Faisalabad and authors clinics and the data were analyzed by using SPSS package, version 12. Almost 93% of the cases were found to be symptom free at the end of follow up, showing the technique used was one of the best techniques for the said clinical problem

hospital based study on future approaches to combat cardiovascular diseases

To determine the opinions of the physicians posted in two tertiary care hospitals of Peshawar regarding future strategies to combat cardiovascular diseases [CVD]. Descriptive observational survey. Khyber teaching hospital [KHT], Hayatabad medical complex [HMC] and department of community medicine Khyber medical college Peshawar. From 20th June to 15 august 2006. A total of 60 clinical experts were selected, 48 from KHT/KMC and 12 from HMC. Medical specialists, general physicians and community experts were included. They were interviewed with a pre-designed questionnaire, prepared in accordance with the objectives of the study. According to the clinicians and general physician's opinion the national approaches to combat cardiovascular diseases should be aimed at: tobacco control legislation and its empowerment [60%], national physical activity policy [70%], check on food quality [21.66%], research promotion in the field of CVD [36.66%], conducting workshops and seminars to educate people about CVD [30%] etc. Community approaches should be more specific towards promotion of healthy activities [71.66%], discouraging smoking [96.66%], and conducting local workshops to increase awareness [26.66%]. Individual approaches to combat CVD is to screen their blood pressure, glucose and lipid profile regularly [85%], stop smoking [96.66%], decrease their weight with exercise [75%], take appropriate medicine in time if is patient or at risk [46.66%] and leadership and advocacy to increase awareness and decrease stigma [43.33%]. while establishing a strategy for combating CVD there is need to offer multiple approaches on national, community and individual levels

hospital based study on future approaches to combat cardiovascular diseases

To determine the opinions of the physicians posted in two tertiary acre hospitals of Peshawar regarding future strategies to combat cardiovascular diseases [CVD]. Descriptive observational survey conducted in Khyber Teaching Hospital [KHT], Hayatabad Medical Complex [HMC] and Department of Community Medicine at Khyber Medical College [KMC] in Peshawar, Pakistan in the period from 20[th] June to 15[th] August 2006. A total of 60 clinical experts were selected, 48 from KHT/KMC and 12 from HMC. Medical specialists, general physicians and community experts were included. They were interviewed with a pre-designed questionnaire, prepared in accordance with the objectives of the study. According to the clinicians and general physicians' opinion the national approaches to combat cardiovascular diseases should be aimed at: tobacco control legislation and its empowerment [60%], national physical activity policy [70%], check on food quality [21.66%], research promotion in the field of CVD [36.66%], conducting workshops and seminars to educate people about CVD [30%] etc. Community approaches should be more specific towards promotion of healthy activities [71.66%], discouraging smoking [96.66%], and conducting local workshops to increase awareness [26.66%]. Individual approaches to combat CVD is to screen their blood pressure, glucose and lipid profile regularly [85%], stop smoking [96.66%], decrease their weight with exercise [75%], take appropriate medicine in time if is patient or at risk [46.66%] and leadership and advocacy to increase awareness and decrease stigma [43.33%]. while establishing a strategy for combating CVD there is need to offer multiple approaches on national, community and individual levels

hospital-based study on future approaches to combat cardiovascular diseases

To determine the opinions of the physicians posted in two tertiary care hospitals of Peshawar regarding future strategies to combat cardiovascular diseases [CVD]. The study was a descriptive observational survey conducted in Khyber Teaching Hospital [KHT], Hyderabad Medical Complex [HMC] and Department of Community Medicine, Khyber Medical College, Peshawar. The study was conducted from June 20 to August 15, 2006. A total of 60 clinical experts were selected, 48 from KHT/KMC and 12 from HMC. Medical specialists, general physicians and community experts were included. They were interviewed with a pre-designed questionnaire, prepared in accordance with the objectives of the study. According to the clinicians' and general physicians' opinion, the national approaches to combat cardiovascular diseases should be aimed at: tobacco control legislation and its empowerment [60%], national physical activity policy [70%], check on food quality [21.66%], research promotion in the field of CVD [36.66%], conducting workshops and seminars to educate people about CVD [30%] etc. Community approaches should be more specific towards promotion of healthy activities [71.66%], discouraging smoking [96.66%], and conducting local workshops to increase awareness [26.66%]. Individual approaches to combat CVD include screening of blood pressure, glucose and lipid profile regularly [85%], cessation of smoking [96.66%], weight control with exercise [75%], compliance in medication [46.66%], and leadership and advocacy to increase awareness and decrease stigma [43.33%]. While establishing a strategy to CVD, there is a need to offer multiple approaches on national, community and individual levels

Endemicity of malaria in Quetta

To determine the endemicity of malaria in Quetta and to evaluate the malarial disease index [DI]. Also, the various modes of presentation of malaria by the prevalent species were also assessed. A cross-sectional study. The study was conducted from January 1994 to December 1998, at the Department of Medicine, Sandeman Provincial Teaching Hospital, Quetta through the courtesy of Malaria Control Program Balochistan. A total of 2.63,018 subjects were included in the study of which there were 151210 [58%] males and 111808 [42%] females. The age range was 10-60 years. After detailed history and clinical examination, finger prick method was used for thick and thin peripheral blood smears for the diagnosis. Out of the total of 2.63,018 subjects who were screened, the positive smears were detected in 91679 [34.85%]. Malarial disease index [DI] was 0.35. P. falciparum was detected in 28166 [30.72%], P. vivax in 61313 [66.87%] and mixed infection in 2200 [2.39%]. Only two symptoms were significantly associated with malaria: fever was present in 62% of P. falciparum, 53% of P. vivax and 65% of mixed infection. Chills were present in 47% of P. falciparum, 41% of P. vivax and 49% of the mixed infection. Other symptoms including vomiting, headache, bodyaches and diarrhoea had a weaker association. Balochistan is a highly endemic malarious area. The high prevalence of infection associated with low prevalence of disease in Quetta shows epidemiologically stable malaria and that in this community malaria transmission is more endemic than epidemic

Severe anaemias in Pakistan

A prospective study on 102 cases of severe anaemia was conducted over a period of 12 months. The patients were distributed into four groups on the basis of haematological investigations. 55 patients were placed in group I of iron deficiency anaemia, 10 in the group II of Haemolytic anaemia, 4 in the group III of hypoplastic anaemia and 33 in group IV of anaemies of Chronic disorders and other miscellaneous diseases. The causes, age distribution, nutritional status and clinical features are reported

Traumatic left ventricular aneurysm

Cardiac ventricular aneurysms are by large ischaemic and tend to develop following a transmural myocardial infarction. In the minority of cases, the cause may be congenital, infective, traumatic or idiopathic. While postinfarction ventricular aneurysms and those which follow cardiac surgery are common, traumatic aneurysms after accidental trauma are rare. We report a case of a true left ventricular aneurysm caused by a bullet injury

Renal osteodystrophy

Renal osteodystrophy embraces the various forms of metabolic bone diseases which develop in chronic renal failure and includes osteomalacia, secondary and tertiary hyper-parathyroidism, osteoporosis and osteosclerosis. Patients with chronic renal failure are common in our community and their prevalence is going to increase in the near future due to prolonged survival of these cases because of frequent use of dialysis and, at times, renal transplantation in their management. Inspite of the fact that renal osteodystrophy is a common complication of end-stage renal failure, and that it is both preventable and treatable. Lack of awareness exists to recognise and treat this condition. The aim of this article is to create an awareness among clinicians to look for this condition in patients with CRF and institute appropriate preventive and therapeutic measures well in time to decrease morbidity from this common complication of CRF. A case history of a patient with advanced renal osteodystrophy is presented followed by discussion