Combination of Hot-Hypertonic Saline and pressure dressing in the management of Parotid Fistula

Parotid fistula is a rare complication of surgical or non-surgical trauma on or in the vicinity of parotid gland. Many pharmacological agents and surgical methods are used to treat it with their own merits, demerits and patient preferences. Injection of hypertonic hot saline along with compression dressing is an economical, patient-preferred and almost complication-free method to deal parotid fistula with promising results

Venous thromboembolism [VTE]: risk assessment in hospitalized patients

To determine the number of hospitalized patients at risk for developing venous thromboembolism [VTE] / deep vein thrombosis [DVT], identifying the most common risk factor and to document the use of thromboprophylaxis. Observational and cross-sectional study. Chandka Medical College Hospital, Larkana, from October to December 2011. A total of 170 patients underwent this study and these included 51 [30%] from general medical, and 119 [70%] from surgical units. Inclusion and exclusion criteria were defined and data was collected on printed format. VTE risk assessment was done according to Caprini Model and criteria defined by the American College of Chest Physicians- ACCP. Out of 170 patients, 91 were male and 79 female with mean age of 39 +/- 16 years. According to ACCP criteria for VTE risk assessment, 20% [n=34] patients were identified to be at low risk, 20% [n=34] at moderate risk, 47.65% [n=81] at high risk and 12.35% [n=21] at very high risk of developing VTE. The commonest risk factor significantly identified was immobility [54.7%, p < 0.005], followed by advancing age [41.17%, p < 0.005] and obesity [18.23%]. The most common risk factor in all types of surgical patients was anaesthesia for more than 45 minutes 82.35% [n=98/119] and in medical patients advancing age 45% [n=23/51]. Only 6 [3.5%] patients received thromboprophylaxis, all were surgical patients of very high-risk category. Majority of studied hospitalized patients were at high risk of developing VTE. Immobility was the commonest risk factor for developing VTE, followed by advancing age and obesity. Very few hospitalized patients actually received thromboprophylaxis

Role of laparoscopy in blunt abdominal trauma

To evaluate the role of laparoscopy in the diagnosis and management of blunt abdominal trauma. This descriptive, prospective study was conducted in the departments of surgery, Ghulam Mohammad Mahar Medical College, Sukkur and Chandka Medical College, Larkana, Pakistan from June 2010 to May 2012. It included 32 patients with blunt abdominal trauma admitted in emergency at GMMMC, Sukkur and at CMC Larkana. Initially, all were resuscitated with iv fluids, analgesics, iv antibiotics and blood transfusion, if required and then investigated by ultrasound abdomen, plain x-ray abdomen and chest and other routine investigations. Laparoscopy was performed in hemodynamically stable patients not showing free gas under the diaphragm in plain x-ray abdomen and ultrasound showing hemoperitoneum. The patients with penetrating abdominal wounds, non-traumatic abdominal emergencies and iatrogenic injuries were excluded. Out of 32 parents, 29 were male and only 3 were female. The age ranged from 12 to 60 years. The organs injured were spleen in 5 [15.6%] patients, liver in 17 [53.12%], omental bleeding in 2 [6.25%], small bowel mesenteric bleeding in 6 [18.75%] and associated Jejunal [injuries in 2 [6.25%] patients. Only 3 [9.37%] patients with Grade-iii liver injury developed post- operative collection, 1 [3.12%] patient developed biliary fistula and 1 [3.12%] developed right sided pleural effusion. No post-operative bleeding or mortality was recorded. Laparoscopy could be useful in selected patients with blunt abdominal trauma as a diagnostic and therapeutic tool, thus avoiding unnecessary laparotomies

Vesico-vaginal fistula abdominal repair versus repair via vaginal route

To evaluate the outcome of Vesico-vaginal Fistulae [VVF] repair by abdominal and vaginal route. Interventional / clinical trial. Department of Urology, Chandka Medical College Teaching Hospital and Almas Medical Centre Larkana. Feb; 2005 to Nov; 2010. After routine clinical examination and investigation, patients having Vesico-vaginal Fistulae [VVF] were selected for repair. All patients had under gone examination those anesthesia [EUA] and cystoscopy. The patients having complex fistulae or associated with urethral, ureteric and colonic involvement or with preexisting malignant pelvic pathology were excluded from the study. Patients were divided in to 02 groups on the basis of the site of the fistula and the method of repair. Group-I comprised of those patients who had low type or uncomplicated fistulae and were operated by vaginal approach. Group-II consisted of those patients who had high type or large fistulae and were operated by abdominal approach. Postoperative follow up was carried out on weekly basis for 03 to 06 months. Our study included 32 cases. Group-I and II comprised of 18 and 14 patients respectively. The mean age was 34 years [ranged from 22 to 45 years]. The main cause of vesico-vaginal fistulae was obstetrical in 28[87.5%] and iatrogenic gynecological [hysterectomy] in 04 [12.5%] patients. No major difficulty was experienced except in 01[0.83%] case in group-1 who had a previous failure history of repair. The mean operative time was 95 minutes [range 80 to 125 minutes] and 145 minutes [range 110 to 175 minutes] in group-1 and group-2 respectively. Peroperative blood transfusion was required in 06 [33.33%] and 13 [93%] patients of group-1 and group-II respectively. Statistically significant difference was found between these two groups [P< 0.05]. Postoperative complications like wound infection occurred in 01[7.15%] of group- 1 and haematuria was present for few days in o4 [22.22%] and 05[35.5%] in group-1 and group-2 respectively. The mean hospital stay was 07 [range 5-10] days. Foleys catheter was removed at 02 week time in all cases. The success rate was achieved 15[83.33%] and in all 14 [100%] cases for group-1 and group-2 respectively and statistically no significant difference was found between two groups [P=NS]. All the patients were followed up regularly except 03 [16.5%] and 05 [35.5%] patients of group-1 and group-II respectively. Long term complications like urinary stress incontinence was observed in 2 [11.1%] patients of group-I, where as small capacity bladder and stone formation was observed in 02[14.3%] of group-11 cases. Birth trauma is still a major cause of vesico vaginal fistula in our region. Although, there is no significant difference in outcome of different technique but interposition of tissue between suture lines have a vital role to achieve a high success rate. Further more, best chance of success achieved with first attempt of repair. Strategic approach and proper training of medical and paramedical staff is recommended

Diffuse fibrous pseudotumor of paratesticular tissue

Paratesticular tumors are uncommon and comprise less than 5% of all intra-scrotal tumors. Fbrous pseudotumours are reactive fibrous proliferations of inflammatory and fibrous tissue, usually in response to surgery, trauma, infection, or inflammation. We present a case of a 25 years old male patient who presented with an asymptomatic firm non-tender right testicular swelling. Plasma HCG and alpha fetoprotein [AFP] levels were within normal limits. A total right orchidectomy and epididymectomy revealed normal testis completely encased by a thick firm fibrotic band of tissue. A diagnosis of diffuse fibrous pseudo tumor of para testicular tissue was made on histology. The possibility of fibrous pseudotumor of paratesticular tissue should be considered in young patients presenting with testicular swellings and normal tumor markers

Leukoplakia of oral cavity; study in population of Karachi

To observe the various histological types of lesions in order to evaluate the different sites involved and correlate the lesions with tobacco use. SETTING: Dental Department of Jinnah Postgraduate Medical Centre Karachi. METHODS: Biopsies from 75 clinically diagnosed patients were examined after staining them with haemotoxylin and Eosin, Masson Trichrome, Periodic Acid Schiff reagent, Reticulin and Grocott Gomori stains. N 38 were males and 37 were females. Maximum number of patients suffering from Leukoplakia were in their fifth and sixth decades with a slight male preponderance. Mixed habits were found in majority of the patients with buccal mucosa being the dominant site. Every white lesion of the oral cavity must be thoroughly investigated as it could result from a simple hyperplastic epithelium up to a frank carcinoma