Frequency of portal hypertensive gastropathy and its relationship with biochemical, haematological and endoscopic features in cirrhosis

To determine the frequency of portal hypertensive gastropathy [PHG] and its relation with biochemical, haematological and endoscopic findings in cirrhotic patients. Cross-sectional analytical study. Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7, from June 2009 to December 2010. Patients with diagnosis of cirrhosis and either undergoing screening upper gastrointestinal [GI] endoscopy or presented with acute upper GI bleeding were included in the study. Portal hypertensive gastropathy and oesophageal varices were classified using Baveno scoring system. The severity of cirrhosis was classified according to the Child-Pugh criteria. Hypersplenism was assessed by the reduction of haemoglobin, leucocytes and platelets. Out of 217 patients, 148 were males [68.2%] and 69 were females [31.8%] with ages ranging from 15-85 years, [mean 48.06 years]. There were 144 HCV +ve patients [66.4%], 36 HBV +ve patients [16.6%], 15 HCV/HBV co-infected patients [6.9%] and only 1 [0.5%] had co-infection of HBV/HDV. Twenty-one patients [9.7%] were classified as having cryptogenic cirrhosis. Out of 172 patients [79.27%], 56 patients [25.8%] had mild and 116 patients [53.5%] were suffering from severe PHG. Significant positive correlation was found between esophageal variceal grade and PHG [r=0.46, p < 0.001] but not with etiology [r=0.05, p=0.41] or hypersplenism [r=0.08, p=0.22]. The frequency of PHG was 79.27% in the studied group. The grade of oesophageal varices had significant relation with PHG that is the severity of PHG increased with the grade of oesophageal varices, suggesting common pathophysiology of both entities

Wide resection and arthrodesis of knee using fibular graft in aggressive giant cell tumor of distal femur

This prospective study was conducted to evaluate the outcome of resection and massive allograft arthodesis in the management of aggressive giant cell tumor of distal femur. 10 Patients with mean age 37.8 years [30-46] with Giant cell tumor, Enneking stage-Ill of distal femur were treated by wide resection and reconstruction allograft arthodesis using free fibular graft and fixed with suitable hardware from July 1999 to 2008. There were 6 female patients and 4 male. Follow up period ranged from 30 to 65 months with an average of 45.3 months. At the final follow up, functional score ranged from 18-27 out of a total of 30. Average was 80.4%, range 66-90%. At the end of follow up all the patients were alive and disease free. All the patients achieved union. The mean union time was 16.4, ranged 14-20 weeks. Two patients had fall and fractured the graft. We had to do revision and additional cancellous grafting. Later on healed full union was achieved. One patient developed superficial wound infection which was treated with systemic antibiotics. In selected patients of giant cell tumor of distal femur, resection arthodesis of knee using fibular graft is an effective reconstructive method. It offers biological reconstruction alternative to amputation in selected patients where mobile joint reconstruction can not be carried out

Wide subtalar release in congenital talipes Equino Varus deformity of foot

There is controversy regarding preferred operative procedure for correction of Congenital Talipes Equino Varus [CTEV]. Objective of this study was to determine the efficacy of wide subtalar release as described by Mackay in 1983 in children having CTEV. Twenty patients up to the ages of 3 with grade-Il, Ill congenital club foot were treated with this procedure; those having deformity secondary to diseases like CP, arthrogryposis multiplex congenital were excluded. Patients were followed for a minimum of one year after operation. Results were graded as per Frank and Hem criteria. Clinical and radiological evaluations were done and compared with other soft tissue procedures. 72.41% patients had satisfactory, 17.24% moderate and 10.34% poor results. Club foot surgery is instituted when well planned cast correction fails. Children up to the age of 3 years can be successfully treated with this method under skilled hands