Classic congenital adrenal hyperplasia: a delayed presentation

Congenital adrenal hyperplasia [CAH] is a rare congenital disorder, which in cases of female genotype may result in virilization. Specific enzyme deficiencies in adrenocorticoid hormones biosynthetic pathway lead to excess androgen production causing virilization. Classic type presents early in infant life as salt losing or simple virilizing type, whereas non classic form presents late at puberty or in adult life. Depending on the type of classic CAH, type of adrenocorticoid deficiency, extent of virilization and genotype, surgical corrective procedures, glucocorticoid and mineralocorticoid replacement therapy are the mainstay of management. We present here a case of classic congenital adrenal hyperplasia of simple virilizing type, which presented later in childhood

Use of amniotic membrane in the treatment oif toxic epidermal necrolysis in burn units

To determine the outcome of the use of Amniotic membrane in the treatment of Toxic Epidermal Necrolysis. Quasi experimental study from 2002 to 2004. Mulitcentric including Plastic, Reconstructive, Microsurgery and Burns Unit, Civil Hospital Karachi, and some private hospitals of Lahore and Karachi. Ten patients with Toxic Epidermal Necroplysis [TEN]. All these patients were treated on the lines of burns patients i.e. I/V fluids, antibiotics, blood transfusions, high protein diet, etc. The only modality which was different, was the daily application of fresh amniotic membrane on the wounds instead of topical silver sulphadazine. Deep wounds were subsequently covered with skin auto grafts. Out of 10 patients with TEN, three were males and seven females. Three female patients expired after five to seven days of stay in the unit, the remaining seven i.e three males and four females survived. On an average the healing time of these seven patients was 33 days. Skin grafting was needed in only one patient. The use of amniotic membrane in TEN patients in specialized burn units will definitely result in better prognosis for these patients

Method of quantitative bacterial count in burn wound

To describe a technique for conducting Quantitative bacteriology in burn wounds, which is a very important tool in the management of burn wound sepsis. Technique was used in 21 patients with burn wound injury. Biopsy for the bacteriology was taken with the help of punch forceps. Then it was directly put into sterilized pre weighed homogenizer bag containing 1ml normal saline. This bag was re-weighed. Weight of the tissue was obtained and bag was homogenized in homogenizer [Stomacher Lab Blender-80]. Four fold dilutions were made of homogenate specimen. From each dilution tube, 0.01ml was then inoculated on blood agar plates, incubated for 24 hours and number of colonies counted by formula. Four specimens were taken each day and repeated on alternate days for up to 6 days. Out of twenty one patients there were 10 male and 11 female with mean age of 25.95 years. Total body surface area burnt was from 9-41%. Bacterial counts obtained varied from 1.45-8.89. Quantitative bacteriology is simple by the above method and should be employed in every public and private sector burn center

Surgical management of tattoos

To study patients coming for surgical removal of their tattoos with regard to treatment outcome. It is a descriptive and observational study, conducted at Plastic, Reconstructive and Micro-Surgery Department of Dow Medical College and Civil Hospital, Karachi over a period of one year. Twenty four patient, 18 males and 6 females, who came for tattoo removal and were found to be psychologically fit, were included in the study. After explaining the treatment consequences they were subjected to either simple excision, serial excision, Dermabrasion or excision and skin grafting. Fourteen cases underwent serial excision, four had simple excisions and closure, three had dermabrasion and three cases excision and over grafting. Infection occurred in one case, dehiscence in one case and incomplete removal of tattoo by dermabrasion in one case. The long term follow up, of up to six months was available only in eight out of twenty four patients. Out of these eight, five developed hypertrophic scars. Though tattoo removal is a simple procedure in the hands of experienced plastic surgeon, it is not free form complications. Though scar is inevitable, patient's satisfaction was quite high as they got rid of stigmas, which was haunting them

Cleft lip day care surgery under infra-orbital nerve block

To study the outcome of Day Care Surgery in adult Cleft Lip patients. Prospective study over a period of one year. Dept. of Plastic Surgery, Civil Hospital, Karachi. Twenty two cases of Cleft Lip that were surgically repaired. All patients, that were selected by the inclusion criteria, underwent surgical repair of the Cleft Lip by Millard Technique under Local anaesthesia i.e. Infra-orbital block. Out of 22 cases operated, 17 were males and five females. Their ages vary from 14 years to 34 years with a mean age of 20.59 years. Thirteen cases were left sided, eight were right sided and one was midline. Twelve cases had Primary Cleft Lip, while 10 cases belonged to the category of Secondary Cleft Lip. During the operation 14 patients felt mild pain, six moderate and two severe pain. The stay in the recovery room was 50 minutes on an average. Day care surgery under local anesthesia of infra-orbital block is suitable for adult Cleft Lip population. It reduces the cost of surgery and the patient's burden on tertiary care hospitals

Health and needs assessment of geriatric patients: results of a survey at a teaching hospital in Karachi

To study the health and needs of geriatric patients. A questionnaire based survey of patients visiting the out-patient department of Aga Khan University was carried out. Ethical requirements were met and included administration of informed consent and provision of confidentiality to patients. Convenience sampling was used without any randomization for interviews. Epi-info and SPSS software were used for data management. Four hundred and two [402] subjects above the age of 65 were surveyed. Most of the subjects were retired [40.5%] married [76.4%] men [69.7%]. Ages ranged from 65 to 90 years, the mean being 70.57 years and 291 [72.4%] had five or more health problems. Mobility impairment, urinary incontinence, dyspnoea, fatigue and visual impairment had the worst impact on the life of the individual. Hypertension [42.5%], diabetes mellitus [28.1%] and arthritis [26.6%] were the most commonly reported chronic ailments. Two hundred and three [50.5%] respondents were taking three or more different medications daily. A large number of people had religion [61.4%], reading [36.1%], socializing [53%] and watching television [49.5%] as a regular activity. Eighty five [21.1%] respondents reported having financial problems. Three hundred and sixty five [90.8%] respondents had spiritual needs and 264 [72.3%] reported that their spiritual needs increased with aging

Penile Torniquet Syndrome

To study the presentation and outcome of cases of Penile Torniquet Syndrome.Retrospective study over a period of five years i.e. Jan.1998 to Dec.2002.Civil Hospital and Usman Memorial Hospital, Karachi, and Allied Hospital, Faisalabad. Patients: Six cases of Penile Torniquet Syndrome.The patients underwent either a two or three stage repair.The ages of the patients ranged from 2-10 years. All patients belonged to the poor socio-economic group. All patients were circumscribed. In all cases the presentation was late with part of the glans just hanging down because of the constriction ring and with a urethro-cutaneous fistula. The results of the surgical repair was good in five cases. One case was lost in follow up. We conclude that although Penile Torniquet Syndorme is a rare condition, but it should be in the mindsof the treating physicians and surgeons so that early diagnosis and prompt treatment can be carried out

Pudendal thigh flap for congenital absence of vagina

To increase the armamentarium of plastic surgeons with description of one of the relatively newer flap for the reconstruction of congenital absence of vagina. All patients of congenital absence of vagina selected for surgery were explained every detail about the procedure. Five out of ten opted for this procedure. In all patients bilateral pudendal thigh flap based on posterior labial artery, a branch of internal pudendal artery, were raised on either side of labia. They were sutured in midline and inserted into the neo-vagina created by dissection in between rectum and urinary bladder. This flap was used in five patients with minor postoperative problems and with good anatomical and functional results. Pudendal thigh flap is a useful technique to reconstruct the vagina

scalping flap for nasal reconstruction

A 50 years old man reported to the out patient, department of Plastic surgery services of Civil Hospital Karachi with a traumatic cut nose by a sharp object. Examination revealed complete loss of both alae, tip and vestibule along with some loss of tissue over the root. The large defect was closed with "scalping flap of Converse" This flap is well known for its reliability, color match and the texture. It causes minimal donor area morbidity